Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review

ProblemCaesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.BackgroundIntrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome.AimThis systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women.MethodsA systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken.FindingsNine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.DiscussionResearch evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.ConclusionThere is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.     

A novel approach based on multiple correspondence analysis for monitoring social networks with categorical attributed data

In in most cases, the distribution of communications is unknown and one may summarize social network communications with categorical attributes in a contingency table. Due to the categorical nature of the data and a large number of features, there are many parameters to be considered and estimated in the model. Hence, the accuracy of estimators decreases. To overcome the problem of high dimensionality and unknown communications distribution, multiple correspondence analysis is used to reduce the number of parameters. Then the rescaled data are studied in a Dirichlet model in which the parameters should be estimated. Moreover, two control charts, Hotelling’s T² and multivariate exponentially weighted moving average (MEWMA), are developed to monitor the parameters of the Dirichlet distribution. The performance of the proposed method is evaluated through simulation studies in terms of average run length criterion. Finally, the proposed method is applied to a real case.     

A stochastically curtailed two-arm randomised phase II trial design for binary outcomes

Randomised controlled trials are considered the gold standard in trial design. However, phase II oncology trials with a binary outcome are often single-arm. Although a number of reasons exist for choosing a single-arm trial, the primary reason is that single-arm designs require fewer participants than their randomised equivalents. Therefore, the development of novel methodology that makes randomised designs more efficient is of value to the trials community. This article introduces a randomised two-arm binary outcome trial design that includes stochastic curtailment (SC), allowing for the possibility of stopping a trial before the final conclusions are known with certainty. In addition to SC, the proposed design involves the use of a randomised block design, which allows investigators to control the number of interim analyses. This approach is compared with existing designs that also use early stopping, through the use of a loss function comprised of a weighted sum of design characteristics. Comparisons are also made using an example from a real trial. The comparisons show that for many possible loss functions, the proposed design is superior to existing designs. Further, the proposed design may be more practical, by allowing a flexible number of interim analyses. One existing design produces superior design realisations when the anticipated response rate is low. However, when using this design, the probability of rejecting the null hypothesis is sensitive to misspecification of the null response rate. Therefore, when considering randomised designs in phase II, we recommend the proposed approach be preferred over other sequential designs.     

Monitoring and change-point estimation for spline-modeled non-linear profiles in phase II

In some applications of statistical quality control, quality of a process or a product is best characterized by a functional relationship between a response variable and one or more explanatory variables. This relationship is referred to as a profile. In certain cases, the quality of a process or a product is better described by a non-linear profile which does not follow a specific parametric model. In these circumstances, nonparametric approaches with greater flexibility in modeling the complicated profiles are adopted. In this research, the spline smoothing method is used to model a complicated non-linear profile and the Hotelling T² control chart based on the spline coefficients is used to monitor the process. After receiving an out-of-control signal, a maximum likelihood estimator is employed for change point estimation. The simulation studies, which include both global and local shifts, provide appropriate evaluation of the performance of the proposed estimation and monitoring procedure. The results indicate that the proposed method detects large global shifts while it is very sensitive in detecting local shifts.     

A Comparison of the Performance of Phase II Simple Linear Profile Control Charts when Parameters are Estimated

The standard deviation of the average run length (SDARL) is an important performance metric in studying the performance of control charts with estimated in-control parameters. Only a few studies in the literature, however, have considered this measure when evaluating control chart performance. The current study aims at comparing the in-control performance of three phase II simple linear profile monitoring approaches; namely, those of Kang and Albin (2000), Kim et al. (2003), and Mahmoud et al. (2010). The comparison is performed under the assumption of estimated parameters using the SDARL metric. In general, the simulation results of the current study show that the method of Kim et al. (2003) has better overall statistical performance than the competing methods in terms of SDARL values. Some of the recommended approaches based solely on the usual average run length properties can have poor SDARL performance.     

基于医疗质量实时监控系统的运行病历书写质量研究

目的:研究医疗质量实时监控系统是否可以提高运行病历的书写质量?方法:对实时监控前后共四年的运行病历书写质量进行回顾性分析,监控前共抽查960份运行病历,监控后检查24 255份运行病历,从运行病历书写的及时性?完整性?内涵质量三方面进行汇总分析?结果:监控前组和监控组比较,及时性达标率由79.4%提升到85.2%(P < 0.001),完整性达标率由94.9%提升到98.2%(P < 0.001),内涵质量达标率由91.8%提升到93.6%(P = 0.114);监控后第二年(2013年)发现运行病历书写及时性?完整性?内涵质量不达标情况分别集中在危重患者病程记录不及时?入院录不完整?日常病程记录内涵质量不高等方面;运行病历书写质量受书写人员的性别?学历?职称?科室因素影响?结论:医疗质量实时监控系统的应用是提高运行病历书写及时性?完整性的有效方法,但对提高运行病历书写的内涵质量效果不明显;女性?高职称?高学历?非手术科室的医务人员运行病历书写的质量较高?     

非对称基坑开挖监测位移下数值对比分析

以南京市青奥轴线地下交通工程主隧道基坑非对称开挖水平位移监测数据为依据,对水平位移监测值与ABAQUS数值模拟值进行对比分析。得出结论:墙体水平位移首先是悬臂开挖的墙顶向外发生三角形分布的位移,然后随着支撑的架设,墙体发生转动,数值模拟值与实际监测值基本符合;在开挖面附近的土压力,随着墙体高度的增加而增大;在支撑以上部分,模拟值要小于计算值,而在开挖面以下部分,则模拟值大于计算值;随着悬臂段开挖深度的增加,悬臂段最大土压力值也在逐渐增加,墙底土压力值在逐渐减小。     

Structural Change Monitoring for Random Coefficient Autoregressive Time Series

A monitoring scheme is proposed to sequentially detect a structural change in random coefficient autoregressive time series of order p (RCA(p)) after a training period of size T. It extends structural change monitoring to RCA(p) time series. The asymptotic properties of our monitoring statistic are established under both the null of no change in parameters and the alternative of a change in coefficient. The finite sample properties are investigated by a simulation study.