INTRODUO A BIOESTATISTICA ULYSSES DORIA FILHO PDF
Capitulo 1 – Download as PDF File .pdf), Text File .txt) or read online. Introducao-Bioestatística – Uploaded by. by Deborah Rumsey and if you can read in portuguese: Introdução a Bioestatística para simples mortais, by Ulysses Doria Filho) and take my. . -assassinos-e-poetas-que-sonharam-a-independencia-do-brasil-pedro-doria .
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Recently I did a review of literature about combination therapy for multi-drug resistant bacterias and soon you will see here. This is gonna be a revolving theme here, so keep your eyes open!
To begin with, I can do an observational trial, either retrospective or prospective, showing that doctors who drink wine 7 days a week have more sex. Go hit the books then. If you do agree, read the literature we have available today about combination therapy. In their majority, the most cited, are observational trials.
Therefore, if you read an article showing a possible association between combined therapy and lower mortality and take this as true I can recommend you two books Statistics for Dummies, by Deborah Rumsey and if you can read in portuguese: This was a unicentric, retrospective study that from evaluated antibiotic combinations to guide therapy in patients with extensively drug-resistant gram negative bacilli XDR GNB infections of any site.
Patients were included if: Here we have a problem, Immortal Time Bias. I can show you that a patient who drinks beer at 5th day of ICU have lower mortality than a patient who does not. Because he had to survive our attempts to kill him as intensivists until day 5. Therefore, beer drinkers have lower mortality than sober patients.
From a statistical point of view, the drinker only begin to exist at day So, if I begin with polimyxin and just after 3 days add amikacin, this guy who recive amikacin is the same that our 5th day drunk guy.
Interestingly, was considered polymyxin use any of: There it is, nebulized and intravenous are the same? Another thing is to realize that the study compares different sites of infection and different bacterias. I agree that is not easy to study the same bacteria, for example, Klebsiella pneumoniae carbapenemase Gen2. Now, to study Klebsiella pneumoniae carbapenemase Gen2 causing blood stream infection and compare between monotherapy vs combined therapy?
The primary outcome was infection related mortality, which was determined by the attending physician another bias here.
Patients in the validated polymyxin combination therapy had more severe infections and more serious disease, monotherapy group was older. Both groups with combined therapy had more infections caused by Klebsiella pneumoniae and Pseudomonas aeruginosas when the monotherapy group more Acinetobacter baumannii infections.
Nothing but the whole bjoestatistica. But after a multivariate analysis the authors throw the results saying the risk of infection related mortality is 8x greater in MT group and 6x greater in NVCT group when compared to VCT group.
Take another look at the antibiotics doses table.
The only group which received polymyxin at adequate dose was the VCT group. Is that honest to compare this group with others? Even if the patients in the VCT group were more sick, it was the only group which received adequate dose treatment.
The median of adequate treatment for monotherapy group was ZERO! And also other strange things happened. The antibiotic dose was included in the multivariate model. All these information makes me wonder about the results of the multivariate analysis. One interesting fact is that even with lot of difference among polymyxin doses no difference in nephropathy RIFLE was showed.
Combination therapy for non-believers, and believers too!
Meaning, if you wanna treat them, do it with the right dose! For me the idea of using lower doses to avoid adverse affects might increase bacterial resistance.
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Moving on… The eligible patients were divided in three groups: Keep this in mind! Data and results Patients in the validated polymyxin combination therapy had more severe infections and more serious disease, monotherapy group was older. Combination therapy for non-believers, and believers too!