Publications by authors named "P Taffé"

88 Publications

When can the Bland & Altman limits of agreement method be used and when it should not be used.

Authors:
Patrick Taffé

J Clin Epidemiol 2021 Apr 20. Epub 2021 Apr 20.

Center for Primary Care and Public Health (unisanté), Division of Biostatistics, University of Lausanne, Switzerland. Electronic address:

Objectives: The Bland and Altman limits of agreement (LoA) method is almost universally used to compare two measurement methods, when the outcome is continuous. The method relies on strong statistical assumptions, which are unlikely to hold in practice. Given the popularity of this simple method, it is timely to explain when it can be safely used and when it should not be used.

Study Design And Settings: Based on a small sample of simulated data where the truth is known, we illustrate what happens when the LoA method is used and the underlying assumptions are violated.

Results: When each measurement method has a different precision or the systematic difference between the two methods is not constant, the LoA method should not be used. For this setting, we refer to an alternative unbiased statistical method, which comes at the cost of having to gather repeated measurements by at least one of the two measurement methods.

Conclusion: The LoA method is valid under very restrictive conditions and when these conditions do not hold the only way out is to gather repeated measurements by at least one of the two measurement methods and use an alternative existing statistical methodology.
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http://dx.doi.org/10.1016/j.jclinepi.2021.04.004DOI Listing
April 2021

Opiophobia in Emergency Department Healthcare Providers: A Survey in Western Switzerland.

J Clin Med 2021 Mar 25;10(7). Epub 2021 Mar 25.

Emergency Department, University Hospital of Lausanne and Lausanne University, Bugnon 46, 1011 Lausanne, Switzerland.

Opiophobia contributes to oligoanalgesia in the emergency department (ED), but its definition varies, and its association to healthcare providers' personality traits has been scantly explored. Our purpose was to study the different definitions of opiophobia and their association with two personality traits of doctors and nurses working in EDs, namely the stress from uncertainty and risk-taking. We used three online questionnaires: the 'Attitude Towards Morphine Use' Score (ATMS), the Stress From Uncertainty Scale (SUS) and the Risk-Taking Scale (RTS). Doctors and nurses from nine hospital EDs in francophone Switzerland were invited to participate. The ATMS score was analyzed according to demographic characteristics, SUS, and RTS. The response rate was 56%, with 57% of respondents being nurses and 63% women. Doctors, less experienced and non-indigenous participants had a significantly higher ATMS (all ≤ 0.01). The main contributors of the ATMS were the fear of side effects and of addiction. In multivariate analysis, being a doctor, less experience and non-indigenous status were predictive of the ATMS; each point of the SUS increased the ATMS by 0.24 point. The fear of side effects and of addiction were the major contributors of opiophobia among ED healthcare providers; opiophobia was also associated with their personality traits.
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http://dx.doi.org/10.3390/jcm10071353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038057PMC
March 2021

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data.

Swiss Med Wkly 2021 Feb 6;151:w20396. Epub 2021 Feb 6.

Department of Family Medicine, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.

Introduction: In the context of an aging population, homecare visits by family physicians may contribute to maintaining older patients at home; however, home visits by family physicians have decreased in number in the last decade with the emergence of homecare-oriented healthcare services. We aimed to describe the diversity of activities and evolution over time of home visits by Swiss family physicians.

Methods: This was a retrospective observational descriptive study. We used billing data collected by the cantonal trust centre for home visits made by family physicians of the canton of Vaud, Switzerland from 2006 to 2015. We separated billed items into specific categories, including the Tarmed catalogue (Swiss pricing system for medical services), laboratory catalogue, medications, medical material and vaccines. We compared billing patterns between emergency and routine visits. We used discrete mixture models to identify cluster classes of visits, and compare their characteristics.

Results: From 2006 to 2015, Vaud family physicians made 451,634 home visits for which they billed a median of 5 items per visit (range 2–95). Most home visits (65%, 293,713) were routine visits consisting of consultation time without additional investigation. We identified four cluster classes of visits comprising routine visits, routine visits with laboratory tests, emergency visits during the day and emergency visits during the night. Routine visits were the main cluster class while emergency home visits were rare.

Conclusions: Family physician home visits are mainly routine visits without additional investigation. Thus, we wonder if a part of this activity could be delegated to other healthcare professionals.
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http://dx.doi.org/10.4414/smw.2021.20396DOI Listing
February 2021

A multicentre study of the trend of adverse events during outpatient anaesthesia in Switzerland during 2000-2016.

Swiss Med Wkly 2020 Oct 28;150:w20365. Epub 2020 Oct 28.

Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.

Background: Over the last three decades, the use of outpatient surgery has been steadily increasing. Simultaneously, there has been an inciting movement to measure and improve healthcare quality and safety. Nevertheless, anaesthesia-related morbidity remains significant. We aimed to evaluate the incidence of intraoperative adverse events (IAEs) occurring during outpatient surgery.

Methods: We used data from the Anaesthesia Databank Switzerland (ADS), a voluntary register. We assessed the overall and specific incidence of IAEs, according to a predefined list of technical, cardiovascular, organisational, respiratory, and general incidents in Switzerland between 2000 and 2016. Primary and secondary outcomes were modelled using multi-level logistic regression analysis, and the time trend on the probabilities of events was assessed.

Results: Between 2000 and 2016, 289,948 outpatient anaesthesia procedures were performed. During this period, the estimated probability of overall intraoperative adverse events decreased from 10.8% to 6.3%, and from 2.3% to 1.4% for technical incidents, from 3.0% to 2.2% for cardiovascular, from 1.6% to 1.3% for organisational, from 0.9% to 0.7% for general, and from 1.1% to 0.7% for respiratory incidents.

Conclusions: The occurrence of intraoperative adverse events in ambulatory anaesthesia has continuously decreased between 2000 and 2016. This trend is essentially attributable to a reduction in the incidence of technical, cardiovascular and organisational events.  .
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http://dx.doi.org/10.4414/smw.2020.20365DOI Listing
October 2020

Impact of incarceration on cardiovascular disease risk factors: a systematic review and meta-regression on weight and BMI change.

BMJ Open 2020 10 16;10(10):e039278. Epub 2020 Oct 16.

Department of Vulnerable Populations and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Vaud, Switzerland.

Objective: Cardiovascular disease is an underappreciated issue in prison medicine. Recent studies have revealed a higher prevalence of cardiovascular disease risk factors (CVDRFs) among individuals in prison, but the impact of incarceration on CVDRFs over time is not well understood. This review aimed to assess available literature and quantify the relationship between incarceration and trends in major CVDRFs in high-income countries.

Design: Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-regression on weight change and obesity.

Data Sources: Medline, Embase, PubMed, Cochrane Central Wiley and Web of Science.

Eligibility Criteria For Selecting Studies: Longitudinal studies reporting on the incidence of, or trends in any CVDRF among current or former people in prison over time, in high-income countries.

Data Extraction And Synthesis: Two authors independently screened articles for eligibility, extracted data and assessed quality using an adapted version of the Newcastle-Ottawa Scale. Trends in CVDRFs during and following incarceration were summarised and in those with sufficient data a meta-regression was performed.

Results: Twenty-six articles were identified. CVDRFs assessed included obesity, hypertension, diabetes, dyslipidaemia, tobacco use, physical inactivity and unhealthy diet. A meta-regression on change in weight during incarceration found a mean increase of 5.3 kg (95% CI 0.5 to 10.1) and change in body mass index of 1.8 kg/m (95% CI -0.9 to 4.6) at 2 years. Weight gain appeared most pronounced right after entering prison and then plateaued at 2 years. Concerning hypertension, the results were inconclusive, despite a trend towards rising blood pressure or prevalence of hypertension during incarceration, and an increased incidence of hypertension following incarceration. Results are contradictory or inconclusive for the other CVDRFs reviewed.

Conclusion: Possible explanations for the association between incarceration and weight include a sedentary lifestyle, unhealthy diet, forced smoking cessation, psychotropic medication use and high levels of stress. Incarceration may be an independent risk factor for cardiovascular disease.
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http://dx.doi.org/10.1136/bmjopen-2020-039278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7569938PMC
October 2020