柳叶刀杂志关于准确透明报告医院感染爆发事件的指南（以及相关不同意见和争议）

David

Review
The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection
关于准确透明报告医院感染爆发事件的指南（以及相关不同意见和争议）
Dr Sheldon P Stone FRCPa, , , Ben S Cooper PhDd, Chris C Kibbler FRCPathb, Prof Barry D Cookson FRCPathe, Prof Jenny A Roberts FFPHMg, Graham F Medley PhDi, Georgia Duckworth FRCPathf, Rosalind Lai MLibc, Prof Shah Ebrahim DMh, Erwin M Brown FRCPathj, Phil J Wiffen MSck and Prof Peter G Davey FRCPl
aAcademic Department of Geriatric Medicine, Royal Free and University College Medical School, London, UK
bMedical Microbiology, Royal Free and University College Medical School, London, UK
cMedical School Library, Royal Free and University College Medical School, London, UK
dStatistics, Modelling and Economics Group, Health Protection Agency, Colindale, UK
eLaboratory of Healthcare Associated Infection, Specialist and Reference Microbiology Division, Health Protection Agency, Colindale, UK
fDivision of Healthcare-associated Infection and Antimicrobial Resistance, Health Protection Agency, Colindale, UK
gCollaborative Centre for Economics of Infectious Disease, London School of Hygiene and Tropical Medicine, London
hDepartment of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
iDepartment of Biological Sciences, University of Warwick, Coventry, UK
jMedical Microbiology, Frenchay Hospital, Bristol, UK
kUK Cochrane Centre, Oxford, UK
lHealth Informatics Centre, University of Dundee Medical School, Dundee, UK

Summary
The quality of research in hospital epidemiology (infection control) must be improved to be robust enough to influence policy and practice. In order to raise the standards of research and publication, a CONSORT equivalent for these largely quasi-experimental studies has been prepared by the authors of two relevant systematic reviews, following consultation with learned societies, editors of journals, and researchers. The ORION (Outbreak Reports and Intervention Studies Of Nosocomial infection) statement consists of a 22 item checklist, and a summary table. The emphasis is on transparency to improve the quality of reporting and on the use of appropriate statistical techniques. The statement has been endorsed by a number of professional special interest groups and societies. Like CONSORT, ORION should be considered a “work in progress”, which requires ongoing dialogue for successful promotion and dissemination. The statement is therefore offered for further public discussion. Journals and research councils are strongly recommended to incorporate it into their submission and reviewing processes. Feedback to the authors is encouraged and the statement will be revised in 2 years.


:wgfbf Reflection and Reaction

Quality of outbreak descriptions in medical literature

Ralf-Peter Vonberga,  and Petra Gastmeiera
aInstitute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Str 1, D-30625 Hannover, Germany

Available online 22 October 2007.




Article Outline
References

In their ORION (Outbreak Reports and Intervention studies Of Nosocomial infection) statement, Sheldon Stone and colleagues call for a standardised manner of reporting nosocomial outbreaks,1 similar to the CONSORT (Consolidated Standards of Reporting Trials) statement for randomised controlled trials (RCTs)[2], [3] and [4] and the TREND (Transparent Reporting of Evaluations of Nonrandomised Designs) statement for raising the standards of other public-health intervention studies.5 In our view, transparent reporting of nosocomial outbreaks is extremely important, because there are many risk factors for pathogen transmission or for the acquisition of a nosocomial infection that cannot be determined by an RCT or non-randomised interventions—for example, for ethical reasons.

But what exactly is the current quality of outbreak reports in the medical literature? To answer that question we screened the Outbreak Database, currently the largest freely accessible collection of all types of nosocomial outbreaks.6 More than 2000 outbreaks have been systematically filed in this database. The “study type” is one of the parameters that can be searched for separately. When using the corresponding guided search mode, we found that 149 of 2096 (7·1%) outbreak reports were cohort studies, which is equivalent to a level of evidence “2b” according to the Oxford Centre of Evidence-based Medicine.7 These levels of evidence range from “1a” for a systematic review of randomised controlled trials to “5” for expert opinion only. 382 studies (18·2%) in the database were case-control studies (evidence level “3b”), of which 24 outbreaks were unable to detect any significant risk factor for the nosocomial infection. Finally, 1565 outbreaks (74·7%) in the Outbreak Database were case reports (evidence level “4”).

Studies of evidence levels “2b” (cohort studies) or “3b” (case-control studies) may or may not come up with possible risk factors for nosocomial infections by themselves. By contrast, because of its nature, a case report is rather unlikely to provide that kind of information.8 Therefore, about three-quarters of all nosocomial outbreaks published in the medical literature barely support new ideas for the prevention of nosocomial infections. Case reports would only be useful for this purpose by an analysis in a systemic review.[9], [10], [11], [12] and [13] However, to summarise the data from different outbreak reports, very specific data from each single event is required, such as detailed descriptions of the patient population, the setting (time and place), possible interventions, and outcomes.

Thus, our findings strongly confirm the need for a standardised manner of outbreak reporting in the future. Applying the ORION statement should make case reports much more profitable for the prevention of nosocomial infections, and it may also improve the quality of cohort, case-control, and cross-sectional studies as previously claimed by the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) statement.

We declare that we have no conflicts of interest.

[ 本帖最后由 David 于 2008-3-6 12:44 编辑 ]

David

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