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Deng J, Ge Y, Yu L, Zuo Q, Zhao K, Adila M, Wang X, Niu K, Tian P. Efficacy of Random Forest Models in Predicting Multidrug-Resistant Gram-Negative Bacterial Nosocomial Infections Compared to Traditional Logistic Regression Models. Microb Drug Resist 2024; 30:179-191. [PMID: 38621166 DOI: 10.1089/mdr.2023.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
This study evaluates whether random forest (RF) models are as effective as traditional Logistic Regression (LR) models in predicting multidrug-resistant Gram-negative bacterial nosocomial infections. Data were collected from 541 patients with hospital-acquired Gram-negative bacterial infections at two tertiary-level hospitals in Urumqi, Xinjiang, China, from August 2022 to November 2023. Relevant literature informed the selection of significant predictors based on patients' pre-infection clinical information and medication history. The data were split into a training set of 379 cases and a validation set of 162 cases, adhering to a 7:3 ratio. Both RF and LR models were developed using the training set and subsequently evaluated on the validation set. The LR model achieved an accuracy of 84.57%, sensitivity of 82.89%, specificity of 80.10%, positive predictive value of 84%, negative predictive value of 85.06%, and a Yoden index of 0.69. In contrast, the RF model demonstrated superior performance with an accuracy of 89.51%, sensitivity of 90.79%, specificity of 88.37%, positive predictive value of 87.34%, negative predictive value of 91.57%, and a Yoden index of 0.79. Receiver operating characteristic curve analysis revealed an area under the curve of 0.91 for the LR model and 0.94 for the RF model. These findings indicate that the RF model surpasses the LR model in specificity, sensitivity, and accuracy in predicting hospital-acquired multidrug-resistant Gram-negative infections, showcasing its greater potential for clinical application.
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Affiliation(s)
- Jinglan Deng
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Yongchun Ge
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lingli Yu
- Infection Management Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiuxia Zuo
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Kexin Zhao
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Maimaiti Adila
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Xiao Wang
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Ke Niu
- School of Nursing, Xinjiang Medical University, Urumqi, China
| | - Ping Tian
- Infection Management Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Health Care Research Center for Xinjiang Regional Population,Urumqi,China
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Birgin E, Müller M, Woll C, Klompmaker A, Téoule P, Reißfelder C, Rahbari NN. Development of a conceptual framework to detect perioperative symptom burden following abdominal surgery for cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106933. [PMID: 37211468 DOI: 10.1016/j.ejso.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Abdominal surgery for gastrointestinal malignancies has a significant impact on patients' health-related quality of life. However, there is so far no patient-reported outcome measures (PROM) in the immediate postoperative period to detect the perioperative symptom burden and patients' needs which may precede occult and severe complications. The aim of the study was to create a conceptual framework for the development of a PROM to measure perioperative symptom burden in abdominal cancer patients. METHODS This mixed method study was performed between March 2021, and July 2021 as part of a multiphase approach to develop a new PROM. A systematic review of the literature was performed health domains were identified. The relevance of the health domains was assessed in a two-round Delphi study with clinical experts. Qualitative interviews were performed in patients who underwent abdominal surgery for cancer. RESULTS The systematic literature review yielded 12 different PROM with 168 items and 55 health domains. The most common health domains involved the "digestive system" and "pain". In total, 30 patients (median age 66 years, 20 men [60%]) were included for qualitative patient interviews. Of 16 health domains identified by the Delphi study, a total 15 health domains were confirmed during patients' interviews. The final conceptual framework included 20 health domains. CONCLUSION This study provides the essential groundwork to develop and validate a new PROM for the immediate postoperative period of patients undergoing abdominal surgery for cancer.
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Affiliation(s)
- Emrullah Birgin
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Christian Woll
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Annika Klompmaker
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Téoule
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Chen X, Wang T, Li Q, Cheng L, Xie Z, Xu J, Yang D. Comparison of Improved Surgical Eight-Step Handwashing Combined with ATP Fluorescence in Detecting the Infection Rate at the Site of Seven-Step Surgical Handwashing and 30-Day Orthopaedic Surgery: A Randomized Study. SCANNING 2022; 2022:3123565. [PMID: 35937673 PMCID: PMC9325653 DOI: 10.1155/2022/3123565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the effects of two hand cleaning schemes on the prevention of surgical site infection in routine orthopaedic surgery. Compared with the standard surgical seven-step washing technique and detected by ATP fluorescence method, the handwashing effects of the improved surgical eight-step washing technique and the standard surgical seven-step washing technique were compared, so as to provide a basis for eliminating the handwashing blind area of the surgical seven step washing technique and improving the surgical handwashing method. METHODS A total of 800 consecutive patients who underwent clean and clean-contaminated orthopaedic surgery between January 1, 2020 and December 31, 2020. Twenty orthopaedic doctors in the operating room of our research team were randomly divided into the improved eight-step washing technique group (improved group) and the traditional seven-step washing technique group (traditional group), with 10 people in each group. Each person was randomly sampled 40 times, 400 people in each group, a total of 800 people, and completed by stages in 12 months. Main Outcome Measures. The infection rate of surgical site 30 days after operation was the primary end point. The qualified rate of fingertip culture was combined with ATP fluorescence in the two groups and three new culture areas in the two groups: the lateral edge of the palm, the medial edge of the palm, and the nail groove of the middle finger and the nail root were secondary end points. RESULTS The 2 protocols were comparable in regard to surgical site infection risk factors. The infection rate of surgical site in the traditional group was 10 cases (2.50%) in 400 cases and 0 cases (0%) in the improved group. Three culture areas were added: the qualified rate of lateral edge of palm, medial edge of palm, and nail groove and nail root of middle finger, and the nosocomial infection rate of surgical incision between the two groups was statistically significant (P < 0.05). There was no significant difference in the qualified rate of fingertip culture (P > 0.05). The handwashing scheme in this study meets the recommended duration of hand disinfection and has good tolerance, and the skin dryness and skin irritation after using aqueous solution are similar. CONCLUSIONS The improved surgical eight-step washing technique combined with ATP fluorescence detection is helpful to eliminate the "blind area" of handwashing. It is also necessary to add three training areas. Handwashing and training are more scientific, rigorous, and effective. They are effective in reducing orthopaedic surgical infection and have application value. They can safely replace the traditional surgical seven-step washing technique, which is worthy of clinical promotion.
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Affiliation(s)
- Xiong Chen
- Department of Operating Room, Xianyou County General Hospital, Putian 351200, China
| | - Tao Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Qinglian Li
- Department of Operating Room, Xianyou County General Hospital, Putian 351200, China
| | - Lixia Cheng
- Department of Orthopedics, Putian Medical District, The 900th Hospital of Joint Logistic Support Force, PLA, Putian 351100, China
| | - Zhimin Xie
- Department of Orthopedics, Putian Medical District, The 900th Hospital of Joint Logistic Support Force, PLA, Putian 351100, China
| | - Jianping Xu
- Department of Orthopedics, Putian Medical District, The 900th Hospital of Joint Logistic Support Force, PLA, Putian 351100, China
| | - Dejian Yang
- Department of Operating Room, Xianyou County General Hospital, Putian 351200, China
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Shehabeldine AM, Hashem AH, Wassel AR, Hasanin M. Antimicrobial and Antiviral Activities of Durable Cotton Fabrics Treated with Nanocomposite Based on Zinc Oxide Nanoparticles, Acyclovir, Nanochitosan, and Clove Oil. Appl Biochem Biotechnol 2022; 194:783-800. [PMID: 34541623 DOI: 10.1007/s12010-021-03649-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
In this study, cotton fabrics based on zinc oxide nanoparticles in situ synthesis, acyclovir, nanochitosan, and clove oil were treated. The treated cotton fabrics were examined by FTIR, HR-TEM, FE-SEM, EDAX, and the surface roughness processing of FE-SEM images. The obtained characterization data emphasized the nano-size of nanocomposite with high homogeneity of particles in spherical shape as well as affirmed the deposition of nanocomposite onto the textile fibers with concluded that the deposition of nanocomposite was increased parallel with sonication time. Antimicrobial and antiviral activities of treated cotton fabrics were evaluated. Results revealed that treated cotton fabrics exhibited promising antibacterial activity toward Gram-positive higher than Gram-negative bacteria. Likewise, treated cotton fabrics are still effective as antibacterial after washing for 100 cycles. Moreover, treated cotton fabrics exhibited potential antifungal activity against Candida albicans, Aspergillus niger, and Aspergillus fumigatus. The antiviral activity significantly depended on the type of virus. The treated cotton fabrics showed antiviral activity against tested viral particles (HSV-1, Adeno, and CoxB2) with viral inhibition of 95.9, 76.4, and 86.9% respectively, while in the case of coated cotton textile with acyclovir, it only exhibited viral inhibition of 49.9, 41, and 22.3% respectively.
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Affiliation(s)
- Amr M Shehabeldine
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt
| | - Amr H Hashem
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt.
| | - Ahmed R Wassel
- Electron Microscope and Thin Film Department, Physics Research Division, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Mohamed Hasanin
- Cellulose and Paper Department, National Research Centre, Dokki, 12622, Cairo, Egypt.
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Zhong X, Wang DL, Mo LF, Zhang W, Xiao LH, Wu XL, Chen YW, Yang L. Evaluation of the quality of COVID-19 prevention and control by a novel comprehensive evaluation model in a tertiary general hospital: a prospective observational study. BMC Public Health 2021; 21:2022. [PMID: 34742268 PMCID: PMC8571898 DOI: 10.1186/s12889-021-12032-9] [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: 06/24/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention and control (P&C) of Corona Virus Disease 2019 (COVID-19) is still a critical task in most countries and regions. However, there are many single evaluation indexes to assess the quality of COVID-19 P&C. It is necessary to synthesize the single evaluation indexes reasonably to obtain the overall evaluation results. METHODS This study was divided into three steps. Step 1: In February 2020, the improved Delphi method was used to establish the quality evaluation indexes system for COVID-19 P&C. Step 2: in March 2020, the CRITIC method was used to adjust the Order Relation Analysis (G1) method to obtain the subjective and objective (S&O) combination weights. The comprehensive evaluation value was obtained using the weighted Efficacy Coefficient (EC) method, weighted TOPSIS method, weighted rank-sum ratio (RSR) method, and weighted Grey Relationship Analysis (GRA) method. Finally, the linear normalization method was used to synthesize the evaluation values of different evaluation methods. Step 3: From April 2020 to May 2021, this evaluation method was used to monitor and assess COVID-19 P&C quality in critical departments prospectively. The results were reported to the departments monthly. RESULT A quality evaluation indexes system for COVID-19 P&C was established. Kendall's consistency test shows that the four evaluation method had good consistency (χ2 = 43.429, P<0.001, Kendall's consistency coefficient = 0.835). The Spearman correlation test showed that the correlation between the combined evaluation results and the original method was statistically significant(P < 0.001). According to the Mann-Kendall test, from March 2020 to May 2021, the mean value of COVID-19 P&C quality in all critical departments showed an upward trend (P < 0.01). CONCLUSIONS The combined comprehensive evaluation method based on the S&O combined weight was more scientific and comprehensive than the single weighting and evaluation methods. In addition, monitoring and feedback of COVID-19 P&C quality were helpful for the improvement of P&C quality.
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Affiliation(s)
- Xiao Zhong
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China.
| | - Dong-Li Wang
- Testing center, Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Lan-Fang Mo
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Wen Zhang
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Li-Hua Xiao
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Xiang-Lin Wu
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Yan-Wei Chen
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Lei Yang
- Tertiary-grade & A-class office, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
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Tchouaket Nguemeleu E, Robins S, Boivin S, Sia D, Kilpatrick K, Dubreuil B, Larouche C, Parisien N, Letourneau J. A pre-pandemic COVID-19 assessment of the costs of prevention and control interventions for healthcare associated infections in medical and surgical wards in Québec. Antimicrob Resist Infect Control 2021; 10:150. [PMID: 34674758 PMCID: PMC8529371 DOI: 10.1186/s13756-021-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare-associated infections (HCAIs) present a major public health problem that significantly affects patients, health care providers and the entire healthcare system. Infection prevention and control programs limit HCAIs and are an indispensable component of patient and healthcare worker safety. The clinical best practices (CBPs) of handwashing, screening, hygiene and sanitation of surfaces and equipment, and basic and additional precautions (e.g., isolation, and donning and removing personal protective equipment) are keystones of infection prevention and control (IPC). There is a lack of rigorous IPC economic evaluations demonstrating the cost–benefit of IPC programs in general, and a lack of assessment of the value of investing in CBPs more specifically. Objective This study aims to assess overall costs associated with each of the four CBPs. Methods Across two Quebec hospitals, 48 healthcare workers were observed for two hours each shift, for two consecutive weeks. A modified time-driven activity-based costing framework method was used to capture all human resources (time) and materials (e.g. masks, cloths, disinfectants) required for each clinical best practice. Using a hospital perspective with a time horizon of one year, median costs per CBP per hour, as well as the cost per action, were calculated and reported in 2018 Canadian dollars ($). Sensitivity analyses were performed. Results A total of 1831 actions were recorded. The median cost of hand hygiene (N = 867) was 20 cents per action. For cleaning and disinfection of surfaces (N = 102), the cost was 21 cents per action, while cleaning of small equipment (N = 85) was 25 cents per action. Additional precautions median cost was $4.1 per action. The donning or removing or personal protective equipment (N = 720) cost was 76 cents per action. Finally, the total median costs for the five categories of clinical best practiced assessed were 27 cents per action. Conclusions The costs of clinical best practices were low, from 20 cents to $4.1 per action. This study provides evidence based arguments with which to support the allocation of resources to infection prevention and control practices that directly affect the safety of patients, healthcare workers and the public. Further research of costing clinical best care practices is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-01000-y.
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Affiliation(s)
- Eric Tchouaket Nguemeleu
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada.
| | - Stephanie Robins
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
| | - Sandra Boivin
- Centre Intégré de Santé et de Services Sociaux Des Laurentides, Direction de la Santé Publique, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | - Bruno Dubreuil
- Centre Intégré de Santé et de Services Sociaux de Laval, Laval, Québec, Canada
| | - Catherine Larouche
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Laval, Canada
| | - Natasha Parisien
- Institut National de Santé Publique du Québec, Quebec City, Québec, Canada
| | - Josiane Letourneau
- Department of Nursing Research, Université du Québec en Outaouais, St-Jérôme Campus, 5, rue Saint-Joseph, Office J-2204, Saint-Jérôme, Québec, J7Z 0B7, Canada
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Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol 2021. [PMID: 34322364 DOI: 10.5662/wjm.v11.i4.116.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.
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Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol 2021; 11:116-129. [PMID: 34322364 PMCID: PMC8299905 DOI: 10.5662/wjm.v11.i4.116] [Citation(s) in RCA: 342] [Impact Index Per Article: 114.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 00000, United Arab Emirates
| | - Ravi Jain
- Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur 302001, Rajasthan, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
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