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M P Becker

Publications and source records attributed to M P Becker.

6 recordsLinked to original sources

Log-linear modelling of pairwise interobserver agreement on a categorical scale.

This article uses log-linear models to describe pairwise agreement among several raters who classify a sample on a subjective categorical scale. The models describe agreement structure simultaneously for second-order marginal tables of a multidimensional cross-classification of ratings. Practical difficulties arise in fitting the models, because models refer to pairwise marginal tables of a very large and sparse table. A standard analysis that treats the marginal tables as independent yields consistent estimates of model parameters, but not of the covariance matrix of the estimates. We estimate the covariance matrix using the jackknife. We apply the models to describe agreement between evaluations made by seven pathologists of carcinoma in situ of the uterine cervix, using a five-level ordinal scale. Previous analyses showed differences among the pathologists in their pairwise levels of agreement, but we observe near homogeneity in the dependence structure of their ratings.

Carcinoma in Situ

Rural motor vehicle crash mortality: the role of crash severity and medical resources.

We did a retrospective case control study to examine the relationship between the risk of dying for Michigan motor vehicle crash (MVC) drivers and the type of county (rural/nonrural) of crash occurrence, while adjusting for crash characteristics, age, sex, and the medical resources in the county of crash occurrence. The 1987 Michigan Accident Census was used to obtain data regarding all MVC driver nonsurvivors (733) and a random sample of all surviving drivers (2,483). County of crash occurrence was defined as rural or nonrural. The crash characteristics analyzed were vehicle deformity, seat belt use, and drivability of the vehicle from the scene. Age and sex of the driver were also analyzed. Medical resource characteristics for the county of crash occurrence were measured as the number of resources per square mile for each of the following: ambulances, emergency medical technicians (EMT), acute care hospital beds, and operating rooms, surgeons and emergency physicians. Also considered were the number and level of emergency rooms in the county of crash occurrence along with the maximum level of prehospital care available (basic life support versus advanced life support) in a county. Before adjusting, the relative risk (RR) for rural MVC drivers dying, compared to their nonrural counterparts, was 1.96. Adjustment for crash characteristics, age, and sex (using logistic regression) decreased the RR to 1.51. An attempt to add medical resource variables to the model resulted in high correlation with the rural/nonrural variable, as well as with each other. This multi-collinearity prevented us from providing a simple explanation of the role of medical resource variables as predictors of survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic

Nursing care requirements of patients with DNR orders in intensive care units.

The purpose of this study was to examine the differences in demographic characteristics and nursing care requirements of patients with and patients without DNR (do not resuscitate) orders in intensive care. The sample consisted of 62 patients with and 62 without DNR orders from the intensive care units of three community hospitals. Data were collected until patients recovered and were transferred from the unit or until death occurred. Data were analyzed by chi-square tests for homogeneity, t tests, and analysis of covariance. Patients with DNR orders were white (p = 0.015), older (p = 0.03), more likely to reside in nursing homes (p = 0.04), had longer intensive care stays (p = 0.0005), were more likely to be admitted from another nursing unit (p less than 0.001), and had higher mortality rates (p less than 0.001). In intensive care settings, patients with DNR orders received more nursing care than patients who did not have DNR orders.

Adult

Preliminary development of two predictive models for DNR patients in intensive care.

The purpose of this study was to identify which variables are the best predictors of a do-not-resuscitate (DNR) classification and develop a model to predict the nursing care required by DNR patients in the ICU. Data collected on DNR and non-DNR patients included nursing care requirements, severity of illness, resource allocation and sociodemographic characteristics. One model identified the best predictors of a DNR classification in intensive care as the origin of admission and the severity of illness score on the day of admission to intensive care. The second model identified the best predictors of nursing care requirements for DNR patients in intensive care as the number of days spent in intensive care prior to the DNR order, the average daily resource allocation points after the DNR order, and the severity of illness score on the day the DNR order was designated.

Aged

Using association models to analyse agreement data: two examples.

Two examples demonstrate how one can use association models to analyse agreement data. The first example concerns intra-rater variability in the classification of sputum cytology slides, and the second deals with variability associated with the reporting of passive smoking histories. The paper emphasizes models in which one estimates category scores from the data, that is models that are not in the log-linear family of models. Such models have use in assessment of category distinguishability and provide insights not easily obtained with log-linear models.

Case-Control Studies

Severity of illness and resource allocation in DNR patients in ICU.

This study examined the differences in severity of illness and resource allocation between patients with do-not-resuscitate (DNR) orders and non-DNR patients in intensive care units. Severely ill intensive care patients with DNR orders continued receiving aggressive medical care following cardiac or respiratory arrest. The continued use of advanced therapies for DNR patients raises important questions about the use of costly intensive care resources.

Adult