1
|
Totton N, Bradburn M, Hoo ZH, Lewis J, Hind D, Girling C, Shepherd E, Nightingale J, Daniels T, Dewar J, Dawson S, Carroll M, Allenby M, Edenborough F, Curley R, Carolan C, Wildman M. Prospectively predicting Pseudomonas aeruginosa infection/s using routine data from the UK cystic fibrosis register. Health Sci Rep 2021; 4:e381. [PMID: 34622017 PMCID: PMC8485591 DOI: 10.1002/hsr2.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/09/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
RATIONALE AND AIMS Lung health of people with cystic fibrosis (PwCF) can be preserved by daily use of inhaled therapy. Adherence to inhaled therapy, therefore, provides an important process measure to understand the success of care and can be used as a quality indicator. Defining adherence is problematic, however, since the number of prescribed treatments varies considerably between PwCF. The problem is less pronounced among those with Pseudomonas aeruginosa (PA), for whom at least three daily doses of nebulized therapy should be prescribed and who thus constitute a more homogeneous group. The UK CF Registry provides routine data on PA status, but data are only available 12 months after collection. In this study, we aim to prospectively identify contemporary PA status from historic registry data. METHOD UK CF Registry data from 2011 to 2015 for PwCF aged ≥16 was used to determine a pragmatic prediction rule for identifying contemporary PA status using historic registry data. Accuracy of three different prediction rules was assessed using the positive predictive value (PPV). The number and proportion of adults predicted to have PA infection were determined overall and per center for the selected prediction rule. Known characteristics linked to PA status were explored to ensure the robustness of the prediction rule. RESULTS Having CF Registry defined chronic PA status in the two previous years is the selected definition to predict a patient will have PA infection within the current year (population-level PPV = 96%-97%, centre level PPV = 85%-100%). This approach provides a subset of data between 1852 and 1872 patients overall and a range of 8 to 279 patients per center. CONCLUSION Historic registry data can be used to contemporaneously identify a subgroup of patients with chronic PA. Since this patient group has a narrower treatment schedule, this can facilitate a better benchmarking of adherence across centers.
Collapse
Affiliation(s)
- Nikki Totton
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
| | - Zhe Hui Hoo
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
- Sheffield Adult Cystic Fibrosis Centre Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| | - Jen Lewis
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
| | - Carla Girling
- Clinical Trials Research Unit, School of Health and Related Research University of Sheffield Sheffield UK
| | - Elizabeth Shepherd
- Department of Adult Cystic Fibrosis University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Julia Nightingale
- Department of Adult Cystic Fibrosis University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Thomas Daniels
- Department of Adult Cystic Fibrosis University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Jane Dewar
- Wolfson Cystic Fibrosis Centre Nottingham University Hospital NHS Trust Nottingham UK
| | - Sophie Dawson
- Wolfson Cystic Fibrosis Centre Nottingham University Hospital NHS Trust Nottingham UK
| | - Mary Carroll
- Department of Adult Cystic Fibrosis University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Mark Allenby
- Department of Adult Cystic Fibrosis University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Frank Edenborough
- Sheffield Adult Cystic Fibrosis Centre Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| | - Rachael Curley
- Sheffield Adult Cystic Fibrosis Centre Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| | - Charlotte Carolan
- Sheffield Adult Cystic Fibrosis Centre Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| | - Martin Wildman
- Sheffield Adult Cystic Fibrosis Centre Sheffield Teaching Hospital NHS Foundation Trust Sheffield UK
| |
Collapse
|
2
|
Caley L, Smith L, White H, Peckham D. Average rate of lung function decline in adults with cystic fibrosis in the United Kingdom: Data from the UK CF registry. J Cyst Fibros 2021; 20:86-90. [DOI: 10.1016/j.jcf.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
|
3
|
Hoo ZH, Campbell MJ, Walters SJ, Wildman MJ. Understanding FEV 1 for the purpose of cystic fibrosis registry comparisons: Does bias in annual review FEV 1 affect between-centre comparison within the UK? An analysis of registry data. J Eval Clin Pract 2020; 26:229-235. [PMID: 30681238 DOI: 10.1111/jep.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVE We previously demonstrated that annual review %FEV1 underestimates lung health of adults with CF compared with %FEV1 captured during periods of clinical stability. This has implications in the comparisons against registries with encounter-based FEV1 , such as the United States. It is uncertain whether this bias affects between-centre comparison within the United Kingdom. Previous funnel plot analyses have identified variation in annual review %FEV1 according to centre size; hence, we investigated whether paired differences between annual review and best %FEV1 also vary according to centre size. METHODS This registry analysis included 18 adult CF centres in the United Kingdom with ≥80% completeness for best FEV1 data in 2014. Mean discrepancy between annual review and best %FEV1 is a surrogate for the extent by which annual review %FEV1 underestimates lung health, and was plotted against centre size. A local polynomial regression (LOESS) curve was used to explore the relationship between the two variables. An appropriate model is fitted based on the LOESS curve to determine the strength of relationship between discrepancies in %FEV1 and centre size. RESULTS There is an inverted U-shaped relationship between mean discrepancies in %FEV1 and centre size. A regression of the paired mean difference in %FEV1 against centre size showed a significant improvement in the goodness of fit for a quadratic model (R2 = 23.8% for a quadratic model compared with 0.4% for a linear one; P = 0.048 for the quadratic term). CONCLUSIONS Annual review %FEV1 underestimated lung health of adults from small and large centres in the United Kingdom to a greater extent compared with medium-sized centres. A plot of %FEV1 against centre size (eg, funnel plot comparison) would be affected by systematic bias in annual review %FEV1 . Therefore, annual review %FEV1 is an unreliable metric to compare health outcomes of adult CF centres within the United Kingdom.
Collapse
Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| | - Michael J Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK
| |
Collapse
|
4
|
Hoo ZH, Curley R, Walters SJ, Campbell MJ, Wildman MJ. Exploring the implications of different approaches to estimate centre-level adherence using objective adherence data in an adult cystic fibrosis centre – a retrospective observational study. J Cyst Fibros 2020; 19:162-167. [DOI: 10.1016/j.jcf.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022]
|
5
|
MacNeill SJ, Pierotti L, Mohammed MA, Wildman M, Boote J, Harrison S, Carr SB, Cullinan P, Elston C, Bilton D. Identifying exceptional cystic fibrosis care services: combining statistical process control with focus groups. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The Cystic Fibrosis (CF) Registry collects clinical data on all patients attending specialist CF centres in the UK. These data have been used to make comparisons between centres on key outcomes such as forced expiratory volume in 1 second (FEV1) using simple rankings, which promote the assumption that those with the highest measures provide ‘better’ care.
Objectives
To explore whether or not using statistical ‘process control’ charts that move away from league tables and adjusting for case mix (age, where appropriate; sex; CF genotype; pancreatic sufficiency; and socioeconomic status) could identify exceptional CF care services in terms of clinically meaningful outcomes. Then, using insight from patients and clinicians on what structures, processes and policies are necessary for delivering good CF care, to explore whether or not care is associated with observed differences in outcomes.
Design
Cross-sectional analyses.
Setting
Specialist CF centres in the UK.
Participants
Patients aged ≥ 6 years attending specialist CF centres and clinicians at these centres.
Main outcome measures
FEV1% predicted.
Data sources
Annual reviews taken from the UK CF Registry (2007–15).
Results
We studied FEV1 in many different ways and in different periods. In our analyses of both adult and paediatric centres, we observed that some centres showed repeated evidence of ‘special-cause variation’, with mean FEV1 being greater than the mean in some cases and lower than the mean in others. Some of these differences were explained by statistical adjustment for different measures of case mix, such as age, socioeconomic status, genotype and pancreatic sufficiency. After adjustment, there was some remaining evidence of special-cause variation for some centres. Our data at these centres suggest that there may be an association with the use of intravenous antibiotics. Workshops and focus groups with clinicians at paediatric and adult centres identified a number of structures, processes and policies that were felt to be associated with good care. From these, questionnaires for CF centre directors were developed and disseminated. However, the response rate was low, limiting the questionnaires’ use. Focus groups with patients to gain their insights into what is necessary for the delivery of good care identified themes similar to those identified by clinicians, and a patient questionnaire was developed based on these insights.
Limitations
Our data analyses suggest that differences in intravenous antibiotic usage may be associated with centre-level outcomes; this needs to be explored further in partnership with the centres. Our survey of centre directors yielded a low response, making it difficult to gain useful knowledge to inform further discussions with sites.
Conclusions
Our findings confirm that the CF Registry can be used to identify differences in clinical outcomes between centres and that case mix might explain some of these differences. As such, adjustment for case mix is essential when trying to understand how and why centres differ from the mean.
Future work
Future work will involve exploring with clinicians how care is delivered so that we can understand associations between care and outcomes. Patients will also be asked for their perspectives on the care they receive.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Stephanie J MacNeill
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Livia Pierotti
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Martin Wildman
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Boote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steve Harrison
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Siobhán B Carr
- Department of Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Diana Bilton
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
McIntyre K, Bertrand DP, Rault G. Using registry data to improve quality of care. J Cyst Fibros 2018; 17:566-572. [DOI: 10.1016/j.jcf.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/09/2018] [Accepted: 06/09/2018] [Indexed: 11/17/2022]
|
7
|
Hoo ZH, El-Gheryani MS, Curley R, Wildman MJ. Using different methods to process forced expiratory volume in one second (FEV 1) data can impact on the interpretation of FEV 1 as an outcome measure to understand the performance of an adult cystic fibrosis centre: A retrospective chart review. F1000Res 2018; 7:691. [PMID: 30443343 PMCID: PMC6213785 DOI: 10.12688/f1000research.14981.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 10/05/2023] Open
Abstract
Background: Forced expiratory volume in one second (FEV 1) is an important cystic fibrosis (CF) prognostic marker and an established endpoint for CF clinical trials. FEV 1 is also used in observation studies, e.g. to compare different centre's outcomes. We wished to evaluate whether different methods of processing FEV 1 data can impact on a centre's outcome. Methods: This is a single-centre retrospective analysis of routinely collected data from 2013-2016 which included 208 adults with CF. Year-to-year %FEV 1 change was calculated by subtracting best %FEV 1 at Year 1 from Year 2 (i.e. negative values indicate %FEV 1 decline), and compared using Friedman test. Three methods were used to process %FEV 1 data. First, %FEV 1 calculated with Knudson equation was extracted directly from spirometer machines. Second, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and Knudson equation. Third, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and GLI equation. In addition, %FEV 1 decline calculated using GLI equation was adjusted for baseline %FEV 1 to understand the impact of case-mix adjustment. Results: There was a trend of reduction in %FEV 1 decline with all three data processing methods but the magnitude of %FEV 1 decline differed. Median change in %FEV 1 for 2013-2014, 2014-2015 and 2015-2016 was -2.0, -1.0 and 0.0 respectively using %FEV 1 in Knudson equation whereas the median change was -1.1, -0.9 and -0.3 respectively using %FEV 1 in the GLI equation. A statistically significant p-value (0.016) was only obtained when using %FEV 1 in Knudson equation extracted directly from spirometer machines. Conclusions: Although the trend of reduction in %FEV 1 decline was robust, different data processing methods yielded varying results when %FEV 1 decline was compared using a standard related group non-parametric statistical test. Observational studies with %FEV 1 decline as an outcome measure should carefully consider and clearly specify the data processing methods used.
Collapse
Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Muhaned S.A. El-Gheryani
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Martin J. Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| |
Collapse
|
8
|
Hoo ZH, El-Gheryani MS, Curley R, Wildman MJ. Using different methods to process forced expiratory volume in one second (FEV 1) data can impact on the interpretation of FEV 1 as an outcome measure to understand the performance of an adult cystic fibrosis centre: A retrospective chart review. F1000Res 2018; 7:691. [PMID: 30443343 PMCID: PMC6213785 DOI: 10.12688/f1000research.14981.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Forced expiratory volume in one second (FEV 1) is an important cystic fibrosis (CF) prognostic marker and an established endpoint for CF clinical trials. FEV 1 is also used in observation studies, e.g. to compare different centre's outcomes. We wished to evaluate whether different methods of processing FEV 1 data can impact on centre outcome. Methods: This is a single-centre retrospective analysis of routinely collected data from 2013-2016 among 208 adults. Year-to-year %FEV 1 change was calculated by subtracting best %FEV 1 at Year 1 from Year 2 (i.e. negative values indicate fall in %FEV 1), and compared using Friedman test. Three methods were used to process %FEV 1 data. First, %FEV 1 calculated with Knudson equation was extracted directly from spirometer machines. Second, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and Knudson equation. Third, FEV 1 volume were extracted then converted to %FEV 1 using clean height data and GLI equation. In addition, year-to-year variation in %FEV 1 calculated using GLI equation was adjusted for baseline %FEV 1 to understand the impact of case-mix adjustment. Results: Year-to-year fall in %FEV 1 reduced with all three data processing methods but the magnitude of this change differed. Median change in %FEV 1 for 2013-2014, 2014-2015 and 2015-2016 was -2.0, -1.0 and 0.0 respectively using %FEV 1 in Knudson equation whereas the median change was -1.1, -0.9 and -0.3 respectively using %FEV 1 in the GLI equation. A statistically significant p-value (0.016) was only obtained when using %FEV 1 in Knudson equation extracted directly from spirometer machines. Conclusions: Although the trend of reduced year-to-year fall in %FEV 1 was robust, different data processing methods yielded varying results when year-to-year variation in %FEV 1 was compared using a standard related group non-parametric statistical test. Observational studies with year-to-year variation in %FEV 1 as an outcome measure should carefully consider and clearly specify the data processing methods used.
Collapse
Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Muhaned S.A. El-Gheryani
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| | - Martin J. Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DP, UK
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital NHS Trust, Sheffield, S5 7AU, UK
| |
Collapse
|
9
|
Dasenbrook EC, Sawicki GS. Cystic fibrosis patient registries: A valuable source for clinical research. J Cyst Fibros 2018; 17:433-440. [PMID: 29555479 DOI: 10.1016/j.jcf.2018.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 02/08/2023]
Abstract
Cystic Fibrosis (CF) patient registries are valuable data sources for researchers studying the natural history, treatment paradigms, and long-term health outcomes of individuals with CF. In this review, we discuss the role of CF patient registries in facilitating comparative effectiveness research, particularly evaluating therapies and variation in health care delivery. We also discuss the limitations of registry-based research, particularly indication bias, as well as statistical methods that can be used to address these issues.
Collapse
Affiliation(s)
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, United States.
| |
Collapse
|
10
|
Hoo ZH, Campbell MJ, Curley R, Walters SJ, Wildman MJ. Do cystic fibrosis centres with the lowest FEV 1 still use the least amount of intravenous antibiotics? A registry-based comparison of intravenous antibiotic use among adult CF centres in the UK. J Cyst Fibros 2017; 17:360-367. [PMID: 29074367 DOI: 10.1016/j.jcf.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Epidemiologic Study of Cystic Fibrosis using 1995-1996 and 2003-2005 data found that CF centres with lowest FEV1 tended to use fewer intravenous antibiotics. We repeated the analyses using 2013-2014 UK CF registry data to determine if this was still the case. METHODS Analysing data for 2013 and 2014 separately, 28 adult CF centres were ranked according to median % age-adjusted FEV1. The top 7 centres were placed in the 'upper quarter' (best FEV1), the bottom 7 centres in 'lower quarter' (lowest FEV1), and the rest in 'middle half'. IV use was stratified according to %FEV1, then compared between the three groups. RESULTS Centres in the 'upper quarter' and 'middle half' used significantly more IV antibiotics compared to centres in the 'lower quarter' (van Elteren test P-value<0.001). Regression analyses showed that people with CF attending centres in the 'upper quarter' or 'middle half' are 30-50% more likely to receive at least one IV course per year compared to people attending centres in the 'lower quarter'. CONCLUSIONS CF centres with lowest FEV1 are still distinguished by lower use of intravenous antibiotics.
Collapse
Affiliation(s)
- Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK.
| | - Michael J Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | - Rachael Curley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK.
| | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | - Martin J Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK; Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK.
| |
Collapse
|
11
|
Stanojevic S. Interpretation of Cystic Fibrosis Centre rankings: Meaningful comparisons or biased statistics? J Cyst Fibros 2017; 16:534-535. [PMID: 28781231 DOI: 10.1016/j.jcf.2017.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children, Toronto, Canada.
| |
Collapse
|