prescriptions issued over...weeks of follow-up were ascertained...

NewAmerica

Senior Member
Mandarin
What is the difference if "follow-up were ascertained" were written as "follow-up were confirmed"?

*******************
The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46).

Source: New England Journal of Medicine July 11, 2019
C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations
 
  • reno33

    Senior Member
    English - USA
    Well, "ascertained" means results were "established/fixed/determined. "Confirmed" means they were positively measured and identified and probably cross-checked for any errors. Quite a difference, actually.
     

    reno33

    Senior Member
    English - USA
    Well, a "confirmed" action would follow an "ascertained" action so it (confirmed) would be the (final) action in a process.

    But no, it doesn't mean that "confirmed" is more rigorous. (A "confirmation" cannot be "rigorous"......a "rigorous confirmation" doesn't mean anything. An "affirmed" confirmation might, but not "rigorous").
     
    Last edited:

    NewAmerica

    Senior Member
    Mandarin
    But a process of cross-checking for any errors should be rigorous in scientific practice. If not rigorously, how can you kick out all errors?

    So it is a bit puzzling to me.
     

    JulianStuart

    Senior Member
    English (UK then US)
    ascertain= to find out definitely; (the investigators obtained reliable information on prescribing decisions)
    confirm = to establish previously uncertain information as correct
     

    NewAmerica

    Senior Member
    Mandarin
    ascertain= to find out definitely; (the investigators obtained reliable information on prescribing decisions)
    confirm = to establish previously uncertain information as correct
    Now ascertain is back on its feet and announces that it is him who's more vigorous than confirm.

    So the situation is complicated.:rolleyes:
     

    JulianStuart

    Senior Member
    English (UK then US)
    Both result in confidence of the correctness of the information, but confirm had some (low-confidence) information beforehand, while ascertain didn’t (although one might have guessed) :)
     

    reno33

    Senior Member
    English - USA
    But a process of cross-checking for any errors should be rigorous in scientific practice. If not rigorously, how can you kick out all errors?
    Easy......the "process" of cross-checking can be "rigorous".......but the "confirmation" itself cannot be "rigorous". As I previously said, the phrase "rigorous confirmation" doesn't mean anything....in the same way that a "rigorous" "certainty, calamity, picnic, etc etc don't mean anything.
     

    Andygc

    Senior Member
    British English
    Try replacing ascertained with discovered. It has much the same meaning here.

    "The antibiotic prescribing decisions made by clinicians at the initial consultation were discovered for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were discovered for 96.9% of the patients.

    You also seem to have wrongly created a phrase "follow-up were ascertained". It is the antibiotic prescriptions (issued over the first 4 weeks of follow-up) that were ascertained.
     

    NewAmerica

    Senior Member
    Mandarin
    Discover implies a quality of unexpectedness, or to be found for the first time, which seems not very suitable for it to be used here. Because antibiotic prescribing appears to be a norm or overused (thus contributing to the rise of superbugs).

    But thank you, of course.
     
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    Andygc

    Senior Member
    British English
    Discover is perfectly correct as a synonym in the context. They did not know what antibiotic prescriptions were made until they asked the prescribers (or examined their records). When they asked they discovered, or ascertained, what had been done.

    As Collins Dictionary puts it:
    to determine or discover definitely
     

    NewAmerica

    Senior Member
    Mandarin
    Oxford Dictionaries define discover as "Find unexpectedly or during a search. "

    The use of antibiotics in the study is expected. What is unclear before the research is the percentage of reducing such use:

    BACKGROUND
    Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).
    The conclusion section reveals which group has low percentage of such use:

    CONCLUSIONS
    CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.
     

    Andygc

    Senior Member
    British English
    You don't understand. The researchers did not know the prescribing decisions. They only knew that antibiotics were likely to be prescribed. Their research discovered what prescribers actually prescribed. The definition you quote does not require the finding to be unexpected: "Find during a search". They searched medical records, and they found the details of antibiotic prescribing. The methodology and outcome of the study are wholly irrelevant to the meaning of "ascertain" in the text you quoted, which here means "find" or "discover". It certainly does not mean "confirm".
     

    NewAmerica

    Senior Member
    Mandarin
    The background section is the context of the entire paper. It is about the way to reduce unnecessary use of antibiotics. Antibiotics are already there, not to be found or discovered. Reducing such without harming patients is the thesis.
     

    Andygc

    Senior Member
    British English
    I do understand the structure of a medical research paper - I have read plenty - but this thread is about the meaning of "ascertain" in the sentence you quoted.

    If you don't understand the difference between expecting antibiotics to be used and finding out (discovering, ascertaining) how and when they were used then I appear to be wasting my time.
     

    NewAmerica

    Senior Member
    Mandarin
    By looking at the records, they did not discover that antibiotics exist. They discovered which antibiotics are being used, in what dosages, etc.
    So the logic is: A doesn't exist but A can be used.
    The problem is that when A can be used, A must exist in the first place.
     

    Myridon

    Senior Member
    English - US
    So the logic is: A doesn't exist but A can be used.
    The problem is that when A can be used, A must exist in the first place.
    No. They know A exists. They are discovering pieces of information about A, not A itself.
    We are discovering that you don't understand "discover". We do not have to start from not knowing that you exist in order to do that.
     

    JulianStuart

    Senior Member
    English (UK then US)
    Discover implies a quality of unexpectedness, or to be found for the first time, which seems not very suitable for it to be used here. Because antibiotic prescribing appears to be a norm or overused (thus contributing to the rise of superbugs).

    But thank you, of course.
    It's the decisions about prescribing (and what percentages of doctors etc) that were the information sought that was discovered/obtained/ascertained.
     

    NewAmerica

    Senior Member
    Mandarin
    Yes, that is about decisions of prescribing antibiotics. Yet in general settings, such decisions have already been overly made, which led the authors to find "a way to reduce unnecessary use of antibiotics" - it is the purpose of the research, it is the background of the study. The word "unnecessary" tells you a story in which physicians tend to use more antibiotics than necessary. So "discover" is not the best word here. For such decisions are not only obvious, but are overly made. Now it is time to find ways to reduce such decisions. The authors confirmed in the conclusion section that CRP testing is such a way.
     

    Andygc

    Senior Member
    British English
    As I said before, the objectives of the study have absolutely nothing whatsoever to do with the meaning of the word "ascertain".

    I read a medical record. By doing so I discover/find/ascertain what the doctor prescribed for his patient. My reason for reading the medical record is irrelevant to my discovery of that information. In the context of the OP the words are synonyms with no substantial difference in meaning. I offered the word discover as an alternative to make clear that ascertain did not mean confirm.
     
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