OHDSI MEETINGS THIS WEEK
Oncology WG - Genomic Subgroup Meeting - Tuesday 9am ET
Oncology WG - Outreach/Research Subgroup Meeting - Tuesday at 10am ET
Oncology WG - Leadership Subgroup Meeting - Tuesday at 10am ET
Gold Standard Phenotype Library WG Meeting - Tuesday at 11am ET
OHDSI Community Call - Tuesday at 12pm ET
CDM & Vocabulary WG Meeting - Tuesday at 1pm ET
PLE + PLP WG Meeting (Eastern Hemisphere) - Wednesday at 8am CT
Oncology WG - Development Subgroup Meeting - Wednesday at 10am ET
Psychiatry WG Meeting - Thursday at 8am ET
Meeting number (access code): 962 271 701
Meeting password: OHDSI
PLE + PLP WG Meeting (Western Hemisphere) - Thursday at 12pm ET
OMOP CDM Oncology WG - CDM/Vocabulary Subgroup Meeting - Thursday at 10am ET
EHR WG Meeting - Friday at 10am ET
You can find a full list of upcoming OHDSI meetings here:
2020 OHDSI Symposium - Scientific Review Committee We’re looking for volunteers to join the 2020 OHDSI Scientific Review Committee. If you’re interested in joining the committee, check out this forum post for more details and email Maura Beaton at firstname.lastname@example.org to volunteer
Favorite 2019 OHDSI Papers - We want to create a thread of the community’s favorite or most inspiring OHDSI papers from the past 12 months.Was there a paper that used OHDSI tools and standards particularly inspiring to you? Please share them here: Favorite OHDSI Papers Of 2019
Two OHDSI studies published in Lancet! Another OHDSI study has been published in Lancet! The EHDEN team’s Rheumatology paper is available here: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(19)30075-X/fulltext
If you haven’t yet checked out the LEGEND hypertension study in the Lancet, you can check it out here:
For more info on the study, check out our press release:
If you want peace, you don’t talk to your friends. You talk to your enemies.
Desmond Tutu COMMUNITY PUBLICATIONS
Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial.
JS van de Maat, D Peeters, D Nieboer, AM van Wermeskerken, FJ Smit, JG Noordzij, G Tramper-Stranders, GJA Driessen, CC Obihara, J Punt, J van der Lei, S Polinder, HA Moll and R Oostenbrink,
PLoS medicine, Jan 2020
Optimising the use of antibiotics is a key component of antibiotic stewardship. Respiratory tract infections (RTIs) are the most common reason for antibiotic prescription in children, even though most of these infections in children under 5 years are viral. This study aims to safely reduce antibiotic prescriptions in children under 5 years with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule.In a stepped-wedge cluster randomised trial, we included children aged 1-60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. The EDs were of varying sizes, from diverse geographic and demographic regions, and of different hospital types (tertiary versus general). In the pre-intervention phase, children received usual care, according to the Dutch and NICE guidelines for febrile children. During the intervention phase, a validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein (CRP) was implemented as a decision rule guiding antibiotic prescription. The intervention was that antibiotics were withheld in children with a low or intermediate predicted risk of bacterial pneumonia (≤10%, based on Feverkidstool). Co-primary outcomes were antibiotic prescription rate and strategy failure. Strategy failure was defined as secondary antibiotic prescriptions or hospitalisations, persistence of fever or oxygen dependency up to day 7, or complications. Hospitals were randomly allocated to 1 sequence of treatment each, using computer randomisation. The trial could not be blinded. We used multilevel logistic regression to estimate the effect of the intervention, clustered by hospital and adjusted for time period, age, sex, season, ill appearance, and fever duration; predicted risk was included in exploratory analysis. We included 999 children (61% male, median age 17 months [IQR 9 to 30]) between 1 January 2016 and 30 September 2018: 597 during the pre-intervention phase and 402 during the intervention phase. Most children (77%) were referred by a general practitioner, and half of children were hospitalised. Intention-to-treat analyses showed that overall antibiotic prescription was not reduced (30% to 25%, adjusted odds ratio [aOR] 1.07 [95% CI 0.57 to 2.01, p = 0.75]); strategy failure reduced from 23% to 16% (aOR 0.53 [95% CI 0.32 to 0.88, p = 0.01]). Exploratory analyses showed that the intervention influenced risk groups differently (p < 0.01), resulting in a reduction in antibiotic prescriptions in low/intermediate-risk children (17% to 6%; aOR 0.31 [95% CI 0.12 to 0.81, p = 0.02]) and a non-significant increase in the high-risk group (47% to 59%; aOR 2.28 [95% CI 0.84 to 6.17, p = 0.09]). Two complications occurred during the trial: 1 admission to the intensive care unit during follow-up and 1 pleural empyema at day 10 (both unrelated to the study intervention). Main limitations of the study were missing CRP values in the pre-intervention phase and a prolonged baseline period due to logistical issues, potentially affecting the power of our study.In this multicentre ED study, we observed that a clinical decision rule for childhood pneumonia did not reduce overall antibiotic prescription, but that it was non-inferior to usual care. Exploratory analyses showed fewer strategy failures and that fewer antibiotics were prescribed in low/intermediate-risk children, suggesting improved targeting of antibiotics by the decision rule.Netherlands Trial Register NTR5326.
Is care safe today?
U Iqbal, H Arshed Ali Khan and YJ Li,
International journal for quality in health care : journal of the International Society for Quality in Health Care, Jan 29 2020