Thinking of the many variables tracked by hospitals and doctors' offices, confidence
intervals could be created for population parameters (such as means or proportions) that
were calculated from many of them. Choose a
...
Thinking of the many variables tracked by hospitals and doctors' offices, confidence
intervals could be created for population parameters (such as means or proportions) that
were calculated from many of them. Choose a topic of study that is tracked (or you would
like to see tracked) from your place of work. Discuss the variable and parameter (mean or
proportion) you chose, and explain why you would these to create an interval that captures
the true value of the parameter of patients with 95% confidence.
Consider the following:
How would changing the confidence interval to 90% or 99% affect the study? Which of
these values (90%, 95%, or 99%) would best suit the confidence level according to the type
of study chosen? How might the study findings be presented to those in charge in an
attempt to affect change at the workplace?
Follow-Up Post Instructions
Respond to at least two peers or one peer and the instructor. Further the dialogue by providing
more information and clarification.
Hi Prof. B and class,
Hi Prof. B and class,
You forewarned us about this topic being challenging, well it is. Holmes (2018) defines
confidence interval as another type of estimate but, instead of being just one number, it is an
interval of numbers. The interval of numbers is a range of values calculated from a given set of
sample data, it is likely to include the unknown population parameter (p. 334). In all hindsight,
this topic got me thinking. I’m not sure how this is tracked in my facility, but we’ve had more
than a few instances of UTI’s with several of our residents and I work in a relatively small skilled
nursing facility (SNF). I would like to see how it’s tracked and what are the criteria used to
prescribe antibiotics, what can we do to prevent recurring UTI's. We’ve had a few residents that
have been sent out to the ER due signs and symptoms, tachycardia, dysuria, change in mental
status, confusion, elevated temp, among some of the symptoms exhibited; one of these residents
has colonized bacteria despite the use of IV abt. A few others have been treated with oral
antibiotics. One of these residents has been prescribed the infectious disease physician antibiotics
indefinitely.
This study by Rousham, Cooper, Petherick, Saukko, and Oppenheim (2019) found,
“overdiagnosis and overtreatment can be understood as a healthcare quality problem”. In this
particular study, they examined the use of dipsticks and urine microbiology among adults aged
≥70 years admitted to acute and community hospitals using a retrospective case series review.
The target sample size was 250 patient records from two hospitals they surveyed. A total of 4227
admissions of adults aged ≥70 years in 2014/2015 with a UTI prevalence of 18%. The estimated
population size of 800 and a 20% prevalence of UTI (95% confidence level, 5% error) a sample
size of 119 patient records at each site would be adequate, so their sample size was rounded to
250 patient records. Of the results of the data reviewed, 14 records (4.5%) had missing medical
records which left 298 available for analysis. The mean age of the sample was 83.6 (SD 7.25)
years, with 70.5% (n=210 female patients). The most prevalent comorbidities in the sample were
cardiovascular disease (69.5%, =207), musculoskeletal disease (36.2%, n = 108), cerebrovascular
disease (25.2%, n = 75) and diabetes (25.1%, n = 41) (Rousham et al.).
This study showed the practices and behaviors and over-prescription of antibiotics. I thought it
was interesting the use of dipstick tests vs urine microbiology. In older adults, diagnosis of UTI
using dipsticks is advised against because the age-related increase in asymptomatic bacteriuria
can cause false-positive results. Guidelines direct against the use of dipstick and recommend the
use of urine microbiology only if signs and symptoms are present for the use of prescribing
antibiotics. Here in the US, according to the American Geriatric Society, “Applying definite
criteria for starting antibiotic therapy in residents of long-term care facilities is likely to reduce
inappropriate antibiotic use without jeopardizing patient safety”. There is a minimum criterion
that physicians must follow that includes positive urine culture plus at least 1 of the following:
• Acute dysuria or acute pain, swelling, or tenderness of the testes, epididymis, or prostate
• Fever or leukocytosis plus 1 of the following:
acute costovertebral angle pain or tenderness, suprapubic pain, gross hematuria, new or
marked increase in incontinence, frequency, or urgency
• In the absence of fever or leukocytosis, then 2 of the following symptoms: acute
costovertebral angle pain or tenderness, suprapubic pain, gross hematuria, new or marked
increase in incontinence, frequency, or urgency
Some challenges that contribute to over-prescription of antibiotics the patient is frail and unwell
or unable to report signs and symptoms. I apologize for making this post long.
Sincerely,
Denise C.
References:
Holmes, A., Illowsky, B., & Dean, S. (2018). Introductory Business Statistics. Houston, TX:
OpenStax.
Mehta, M. J., & Rowe, T. A. (2015). Infectious diseases. American Geriatrics Society, Inc.
Rousham, E., Cooper, M., Petherick, E., Saukko, P., & Oppenheim, B. (2019). Overprescribing
antibiotics for asymptomatic bacteriuria in older adults: a case series review of admissions in two
UK hospitals. Antimicrobial resistance and infection control, 8, 71. doi:10.1186/s13756-019-
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