Landbruksbebyggelse 2000 : Kvalitetskontroll av informasjon om landbruksbebyggelse ved kobling av registre

Tradisjonelt har landbruksstatistikk fokusert på driftsenheter og aktivitet i landbruksnæringen. Hva som skjer med bosetting og bygninger på gårder uten aktiv drift fanges i liten grad opp i statistikken, og det er denne problemstillingen vi har tatt tak i dette prosjektet. Hovedmålet for prosjektet har vært å gjennomføre og dokumentere en kvalitetssjekk av eksisterende registerinformasjon om landbruksbebyggelse som grunnlag for videre statistikkproduksjon. Forutsatt bearbeiding og hensiktsmessig tilrettelegging vil resultatene fra prosjektet kunne være nyttige som delverktøy for å følge endringer i bosetting og landskapsutvikling i rurale strøk. Informasjon fra Grunneiendoms-, Adresse- og Bygningsregisteret (GAB) er i prosjektet koblet sammen med informasjon fra Landbruksregisteret og Jordbrukstellingen 1999 (JT 1999). Antall bosatte på eiendommene er hentet fra Det sentrale folkeregisteret. En egen kobling mot SEFRAK-registeret gjør at vernestatus for bygg er knyttet til den enkelte bygning

Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study

Introduction: Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs). Methods: We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen's ?. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria. Results: Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (? ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician's diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria. Conclusions: Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis

Landbruksbebyggelse 2000 : Kvalitetskontroll av informasjon om landbruksbebyggelse ved kobling av registre

Tradisjonelt har landbruksstatistikk fokusert på driftsenheter og aktivitet i landbruksnæringen. Hva som skjer med bosetting og bygninger på gårder uten aktiv drift fanges i liten grad opp i statistikken, og det er denne problemstillingen vi har tatt tak i dette prosjektet. Hovedmålet for prosjektet har vært å gjennomføre og dokumentere en kvalitetssjekk av eksisterende registerinformasjon om landbruksbebyggelse som grunnlag for videre statistikkproduksjon. Forutsatt bearbeiding og hensiktsmessig tilrettelegging vil resultatene fra prosjektet kunne være nyttige som delverktøy for å følge endringer i bosetting og landskapsutvikling i rurale strøk. Informasjon fra Grunneiendoms-, Adresse- og Bygningsregisteret (GAB) er i prosjektet koblet sammen med informasjon fra Landbruksregisteret og Jordbrukstellingen 1999 (JT 1999). Antall bosatte på eiendommene er hentet fra Det sentrale folkeregisteret. En egen kobling mot SEFRAK-registeret gjør at vernestatus for bygg er knyttet til den enkelte bygning

New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality

Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints

Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p &lt; 0.001). European patients were younger (median, 1 vs 6 yr; p &lt; 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p &lt; 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis