Biostat Case Study

There are seven questions at the end of this article. This assignment is worth 80 points. Place answers in this table:

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BIOSTAT Case Study: Tests of Association for Categorical Data
LEARNING OBJECTIVES
At the completion of this Case Study, participants should be able to:
 Compare two or more proportions
 Calculate and interpret confidence intervals for proportions
 Understand the impact of expected values on the choice of statistical test used to compare proportions
 Interpret the results of tests of association
 Interpret logistic regression results.

Suggested Citation: New Jersey Medical School Global Tuberculosis Institute. /Incorporating Tuberculosis into Public Health Core Curriculum./ 2009: BIOSTATISTICS CASE STUDY 2: Tests of Association for Categorical Data STUDENT Version 1.0.
Introduction
This exercise is based on the following study. Sections of this document have been reprinted with permission of the journal.

Factors influencing the successful treatment of infectious pulmonary tuberculosis W-S. Chung,*† Y-C. Chang,† M-C. Yang†, * Department of Internal Medicine, Hualien General Hospital, Hualien, † Institute of Health Care Int J Tuberc Lung Dis 11:59-64 © 2007 The Union

The abstract states that “(t)his study used a population-based…design. All PTB [pulmonary TB] patients residing in southern Taiwan recorded in the tuberculosis registry from 1 January to 30 June 2003 were identified. Each patient’s medical record was requested from treating hospitals and retrospectively reviewed for 15 months after the date PTB was confirmed.” 1

Following is the methods section of this article1.
METHODS
We carried out a population-based medical record review in southern Taiwan, where the only chest specialty hospital geared towards specialized thoracic disease care, mainly for TB, is located. Hospitals and primary practitioners that provided TB care in the same region can be used as comparative care providers. Study areas include Chiayi County, Chiayi City, Tainan County and Tainan City. As mandated by law in Taiwan, all suspected and confirmed TB cases must be reported in a timely manner to the national computerized registry maintained by the Taiwan Center for Disease Control (CDC). Reporting of cases has been encouraged and reinforced through the implementation of a no-notification, no-reimbursement policy and a notification-for-fee policy since 1997. 7 We requested data on all suspected and confirmed TB patients residing in the studied areas and recorded in the registry for the period 1 January to 30 June 2003. The study team, including four registered nurses (each with a minimum of 6 years’ clinical experience), two head nurses (each with a minimum of 12 years’ clinical experience) and one pulmonologist, had undergone a series of training courses designed to ensure proper validation of data consistency. Site visits were arranged to review the medical record of each patient, and the 15-month follow-up of medical records after start of treatment was reviewed.

Health care institutions
Health care institutions that had ever reported cases in the study areas included the chest hospital, two academic medical centers, 11 regional hospitals and 15 district hospitals and primary practitioners (district hospitals and primary practitioners are regarded as being at the same level in terms of TB treatment). In Taiwan, institutions are classified by the government as follows: ‘medical centers’ are health care, training and research facilities that house over 500 acute-care beds; ‘regional hospitals’ have no fewer than 250 acute care beds and are staffed by physicians of various specialties with the purpose of providing health care services to patients and training for specialists; and ‘district hospitals’ provide primary health care services similar to those offered by primary practitioners but with the added availability of in-patient care.

Infectious PTB
Infectious PTB is defined as sputum culture-confirmed disease caused by Mycobacterium tuberculosis, or two sputum smear examinations positive for acid-fast bacilli (AFB) or one positive sputum examination, radiological signs and a clinician’s decision to treat.8

Directly observed treatment
For directly observed treatment (DOT), a health worker or other trained person who is not a family member watches as the patient swallows anti-tuberculosis medicines for at least the first 2 months of treatment.1 DOT thus shifts the responsibility for cure from the patient to the health care system. In Taiwan, whether or not the patient is receiving DOT, TB is treated using WHO-recommended regimens; the initial phase consists of 2 months of isoniazid (H), ethambutol (E), rifampicin (R) and pyrazinamide (Z), followed by a 4-month continuation phase consisting of H, E and R (2HERZ/4HER).9,10

Treatment success
Treatment success is defined as a patient who has been cured or has received a complete course of treatment. A cured case is defined as a PTB patient who has finished treatment with a negative bacteriology result during and at the end of treatment. A case recorded as completed treatment is defined as a PTB patient who has finished treatment, but who has not met the criteria to be defined as a cure or a failure.11,12

Ethical consideration
The study was approved by the Taiwan CDC. All staff members involved in the study signed a statement of agreement to maintain patient confidentiality.

Data analysis
Bivariate analyses with ï£2 tests were used to compare differences in proportions of dichotomous and categorical variables, which extracted potential predictors of successful treatment. We then performed multivariate logistic regression analyses on the potential predictors with P PLACE THIS ORDER OR A SIMILAR ORDER WITH WWW.SPEEDESSAYS.COM TODAY AND GET AN AMAZING DISCOUNT

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