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Guidelines for systematic review in conservation and environmental management.

An increasing number of applied disciplines are utilizing evidence-based frameworks to review and disseminate the effectiveness of management and policy interventions. The rationale is that increased accessibility of the best available evidence will provide a more efficient and less biased platform for decision making. We argue that there are significant benefits for conservation in using such a framework, but the scientific community needs to undertake and disseminate more systematic reviews before the full benefit can be realized. We devised a set of guidelines for undertaking formalized systematic review, based on a health services model. The guideline stages include planning and conducting a review, including protocol formation, search strategy, data inclusion, data extraction, and analysis. Review dissemination is addressed in terms of current developments and future plans for a Web-based open-access library. By the use of case studies we highlight critical modifications to guidelines for protocol formulation, data-quality assessment, data extraction, and data synthesis for conservation and environmental management. Ecological data presented significant but soluble challenges for the systematic review process, particularly in terms of the quantity, accessibility, and diverse quality of available data. In the field of conservation and environmental management there needs to be further engagement of scientists and practitioners to develop and take ownership of an evidence-based framework.

Animals↗

Does imbalance in phylogenies reflect only bias?

Phylogenetic tree imbalance was originally believed to indicate differences in evolutionary rates within trees, but other sources of imbalance have been identified, such as tree incompleteness and low quality of the data. To examine the effect of data quality, I calculated Colless's index for 69 recent complete phylogenies. On average, these phylogenies were more unbalanced than phylogenies generated by the equal rates Markov (ERM) model. I tried Mooers's (1995) method to correct for tree size, but his measure appeared to become dependent on tree size when there are large trees (i.e., > 14 tips) in a collection. Instead I corrected for tree size by taking the difference between Colless's index of observed trees and the ERM model expectation for a tree of the same size. The balance measure thus obtained did not correlate significantly to consistency and retention indices as indicators of data quality. It was also independent of the factors kingdom (plants and animals) and taxon level at the tips and type of data (molecular, morphological, and combined).

Bias↗

Intracranial compliance as a bed-side monitoring technique in severely head-injured patients.

A recently developed monitoring technology makes an on-line assessment of intracranial compliance (ICC) possible. Aims of our research: 1. Course and values of ICC (critical threshold: < 0.5 ml/mmHg) in episodes of pathological intracranial pressure (ICP) (> 20 mmHg) and reduced cerebral oxygenation (brain tissue PO2 (PtiO2) < 10 mmHg). 2. Mean ICC in different ages. 3. Relationship between ICC and outcome. 4. Evaluation of ICC as routine monitoring parameter by calculation of s.c. time-of-good-data-quality (TGDQ). Computer data assessment of 7 patients with severe closed head-injury was performed providing 830 hours of data. TGDQ resulted from the formula: TGDQ (%) = artifact free time (min) x 100 (%)/total monitoring time (min). Outcome was assessed 6 months posttrauma (Glasgow Outcome Score (GOS). 1. Analysis revealed 43 episodes of pathologically elevated ICP and 39 of critical ICC. In 17 cases overlapping periods were found. In 9 of these ICC preceded ICP. Reduced cerebral oxygenation was neither related with high ICP nor low ICC. 2. ICC was found to be age-related. At a cut-off-point of 20 mmHg in ICP, ICC in children (< or = 16 years) was 0.9, in adults (17-60 years) 0.7 and in elderly (> 60 years) 0.6 ml/mmHg. 3. Adverse outcome was indicated best by high ICP (up to 45% of monitoring time) followed by low ICC (up to 41% of monitoring time). 4. TGDQ in ICC was 72% compared to 95% in ICP and 98% in PtiO2. In predicting adverse outcome, ICP was equal to ICC. The different ICC in each age class points to the need of age-adjusted thresholds. Further refinements of ICC technology are needed to improve ICC data quality and therefore become a useful tool in neuromonitoring.

Adolescent↗

[Quality of data on myocardial infarction deaths, Brazil].

OBJECTIVE: To evaluate the quality of data on acute myocardial infarction deaths from mortality information systems. METHODS: Data on in-hospital acute myocardial infarction mortality collected from database of the Mortality Information System (SIM) and Hospital Information System (SIH), in 2000, were analyzed. Then data collected from medical records from two hospitals affiliated to the Unified Health System (SUS) in Rio de Janeiro, Brazil, were also analyzed. Medical records, death certificates, and hospital admission forms (AIH) were compared using the World Health Organization criteria of acute myocardial infarction diagnosis. Agreement among different sources was analyzed using Cohen's Kappa statistics and intraclass correlation coefficient. RESULTS: In-hospital death registries in SIM are much larger than in SIH/SUS. There were identified three mechanisms that could explain most of the observed discrepancy: missing hospital admission forms (32.9%), different main diagnosis registered in SIH/SUS (19.2%), and under reporting of deaths in hospital admission forms (3.3%). The medical records review could confirm the diagnoses of acute myocardial infarction in 67.1% of all deaths reported in death certificates. The sensitivity of data on acute myocardial infarction deaths in death certificates was about 90% for both health information systems analyzed. CONCLUSIONS: There is a need for actions to improve the quality of data registered in SIH/SUS such as standardization of criteria for issuing hospital admission forms during hospital emergencies and training local staff on registration systems.

Brazil↗

Administrative data for quality improvement.

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

Birth Weight↗

Health care quality: from data to accountability.

The many audiences for information about the quality of health care have different and sometimes conflicting interests and priorities. This is reflected in the diversity of current efforts to use health care data to identify, measure, and demonstrate quality. The author surveys three of these approaches in depth: (1) the professional approach, which relies on the actions of private-sector accreditation groups, trade associations and health plans, hospitals, and other providers to assure quality; (2) the market-driven approach, which relies on the use of quality data by health care purchasers and consumers in choosing plans and providers; and (3) the public-sector approach, which relies on the regulatory, oversight, and purchasing actions of government at the federal, state, and local levels to assure quality. The author concludes that efforts to measure and report the quality of health care invariably confront a variety of technical and political issues. Several observers maintain that it is more important for participants in quality issues to reach consensus on the issues than to reach technical perfection in the way the data are handled. Important obstacles in the technical realm include inadequate investment in sufficiently sophisticated and compatible information systems and the fact that where such systems are in place, they generally cannot be linked. But efforts, both technical and legal, are under way to overcome these obstacles. Even so, some of the issues of health care quality will remain moving targets because of constant changes in the health care environment and in technology. The author closes with the hope that the various actors within the health care industry may coordinate their efforts in dealing with these issues.

Accreditation↗

The optimum granularity for coding diagnostic data in primary care: report of a workshop of the EFMI Primary Care Informatics Working Group at MIE 2005.

INTRODUCTION: The EFMI Primary Care Informatics Working Group held a workshop to explore interventions used across Europe to improve the data quality in primary care computerised medical records. METHOD: A plenary session reviewed the UK literature about improving data quality and then the session split into three small groups. Fifteen delegates from nine countries contributed to the workshop. These groups reported back at the end of the session. RESULTS: The groups defined what they meant by data quality. The principal requirement was that data must be 'fit for purpose'. The participants felt this was particularly important for diagnostic data, while recognising that the purpose might not be known at the point of data recording. They also described the barriers to recording structured and coded data. The most important were an inappropriate interface with the coding system and inappropriate granularity of codes. There was a wide range of suggestions as to how to overcome these barriers, including providing feedback, links to expert systems, education and training, use of the data for care elsewhere in the health system and mandation of electronic data recording. CONCLUSIONS: The workshop developed a new characteristic of data quality: 'fit for purpose'. This is different from definitions that focus on completeness, accuracy, currency, or its positive predictive value and sensitivity. The group also highlighted the importance of data quality of diagnoses, as these data are important throughout the health system as well as acting as a prompt for other interventions within the individual consultation. More research is needed into appropriate levels of granularity for diagnostic recording in primary care.

Diagnostic Tests, Routine↗

Pneumonia--the quality of medical records data.

The quality of medical records data for patients who were hospitalized with community-acquired pneumonia was assessed by comparing medical records data with data obtained in a prospective study of pneumonia for the period April 1, 1984, to December 31, 1984. One hundred five patients fulfilled the case definition of pneumonia for entry into the prospective study. One hundred twenty-seven patients were identified by medical records data. Seventy-three of the patients appeared in both studies. The positive predictive accuracy of the medical records data was 57%. When the etiologic diagnoses for the 73 patients identified by both studies were compared, there was agreement only 52.6% of the time. Streptococcus pneumoniae was overdiagnosed, and Mycoplasma, specific viral causes, and Haemophilus influenzae were not recorded by the medical records data. The quality of medical records data regarding pneumonia can be improved by changing the current ICD-9-CM coding system for pneumonia and by providing instruction and an algorithm for abstractors to follow in assigning a diagnosis of pneumonia.

Humans↗

[Quality of data on folic acid content in vegetables included in several Spanish Food Composition Tables and new data on their folate content].

The relationship between adequate folate intake, adequate serum levels, and lowering the risk of suffering from cardiovascular diseases, neural tube defects, neural illness and some kind of cancers have been widely studied. Because of the expected health benefits, the consumption of foods with high folate content or enriched foods is increasing. Therefore, an adequate folate intake is important in order to reach acceptable serum levels. Reliable food composition data are necessary in order to evaluate and estimate the populations folate intake, elaborate diets and formulate recommended dietary intakes. For this reason, we revised folic acid data in Spanish Food Composition Tables (FCT). The quality of the data was evaluated and compared with other well-known international Food Composition Tables as well as with a high-resolution liquid chromatographic method (HPLC) validated in our laboratory. We evaluated all data about folate content, as well as all the information given like data origin, analytical method, sampling or original database. For the HPLC method, the food samples were incubated with hog kidney conjugase. After that, the samples were purified and concentrated by strong anion exchange (SAX), then the folate content was quantified by HPLC with a combination of two ultraviolet and fluorescence detectors. The evaluation and comparison of data was established according to some parameters, which define the quality of data, giving punctuation depending on the compliance with these parameters. The study of different sources showed that nutrients were different in definition, analysis method, units and expression of data, and that this fact could have a potential influence on TCA data values. In addition, it has been possible to show a wide variation in food number, name of these foods as well as the analysis of raw or cooked products with different composition. When the quality conditions were tested, the Spanish FCT had the lowest punctuation in folate content data. That is because the Spanish FCT did not use a validated method to quantify folic acid in foods (Direct method of FCT elaboration), but they used folate content data from others FCT (Indirect method of FCT elaboration). These data manifest the importance of getting a consensus method to determine folate content in foods with the aim to obtain a FCT with reliable folate data.

Folic Acid↗

Quality of data in the Manchester orthopaedic database.

OBJECTIVE: To determine the completeness and accuracy of data in a computerised clinical information system (Manchester orthopaedic database) in comparison with the data available through the Hospital Activity Analysis. DESIGN: Retrospective review of case notes, computer data, and Hospital Activity Analysis data. SETTING: Orthopaedic unit in a district general hospital in Manchester. SUBJECTS: 200 random patient records distributed through the period of use of the computer system (1 October 1988 to 31 March 1990) and 121 records for random admissions between 1 April 1989 and 31 March 1990, 71 of which were included in the previous sample. MAIN OUTCOME MEASURES: Conformity of the computer record key words and Hospital Activity Analysis codes to an ideal key word record and ideal code record drawn up by one investigator from the clinical notes; overall quality (completeness times accuracy). RESULTS: Overall completeness of the data in the orthopaedic database was 62% and the accuracy was 96%. Completeness improved after feedback to doctors on the use of key words in regular audit meetings. Completeness was higher in inpatient than outpatient records (69.9% v 53.7%, p less than 0.001) and when a new key word was required compared with missing and incorrect key words (both p less than 0.001). Completeness was lower when the key word was required of a senior registrar (p less than 0.05). Accuracy was not significantly different. The completeness of Hospital Activity Analysis data was 90.5% and accuracy 69.5%. Thus the overall data quality was similar in both systems. CONCLUSIONS: Even in a system designed for simple and efficient data capture, compliance by users was poor. Accuracy was high, suggesting that users understood the principles of data entry. Completeness of data capture can be improved by providing feedback to users on use of the system and performance. Improvements in future versions of the software should improve performance.

Abstracting and Indexing↗

[Quality of data on computerized registration of postoperative wound infections].

At the Department of General Surgery, Hillerød Hospital, the quality of data from a continuous registration of post-operative wound infection was evaluated. Data registered over a six-month period were compared with data available in caserecords and data from a questionnaire sent to the patients. During the period 1.2-31.7.1990 924 operations were registered in 864 patients. Eight hundred and ninety-five patient records could be traced and 770 questionnaires were sent. The remaining 125 were dead or had unknown addresses. Six hundred eighty-seven questionnaires were returned. The data-registered overall infection rate was 3.0%. The actual infection rate was 8.9%. Fifty-eight percent of the infections noted in the records were registered. Approximately 40% of the infections were diagnosed and treated in general practice only. It is concluded that in order to compare infection rates between departments, it is necessary to ensure that equal definitions and equal quality of the data are used. Strict routines in the department and a close contact to the general practitioners are essential to achieve a satisfactory quality of data.

Denmark↗

How good are my data?: Information quality assessment methodology.

Quality assurance techniques used in software development and hardware maintenance/reliability help ensure that data in a computerized information management system are maintained well. However, information workers may not know the quality of data resident in their information systems. Knowledge of the quality of information and data in an enterprise provides managers with important facts for managing and improving the processes that impact information quality. This paper presents quality assessment methodology to assist information workers in planning and implementing an effective assessment of their information data and quality. The areas covered include: identifying appropriate information quality indicators; developing assessment procedures; conducting information quality assessments; reporting information assessment results; tracking improvements in information quality.

Computers↗

Quality of data reported on abdominal aortic aneurysm repair--a comparison between a national vascular and a national administrative registry.

OBJECTIVE: To study consistency of data and completeness of reporting in a national vascular registry, NorKar, and a national administrative registry, The Norwegian patient register (NPR). DESIGN: Comparative registry-based national study supplemented with a comprehensive control of patients registered in one major hospital. MATERIAL: All patients registered with a procedure-code for treatment of AAA in NorKar or NPR during 2001 or 2002, were included. METHOD: We compared the reporting of procedure-codes, diagnosis-codes and in-hospital deaths after treatment for abdominal aortic aneurysm (AAA) in the two registries to evaluate completeness. Consistency between procedure-codes and diagnoses were evaluated within both registries. Completeness of reporting to one NorKar Local Registry was investigated in more detail in one of the hospitals. RESULTS: Compared with the NPR numbers, NorKar contained 69% of the patients treated for AAA in Norway, while completeness for NorKar member hospitals was 84%. The detailed investigation in one of the hospitals showed a completeness of 91% and a false inclusion of 5.3% of all cases treated for AAA. The consistency between procedure-codes and diagnosis-codes was 93% in both registries. We found evidence of substantial underreporting of in-hospital deaths to NorKar in several hospitals. Overall reporting of early deaths to NorKar relative to completeness of reported cases was estimated to 72%. CONCLUSION: There is an underreporting of patients with AAA to NorKar according to the NPR numbers and a need for better control of procedure-diagnosis consistency in both registries. There seems to be a substantial underreporting of early deaths to NorKar. Introduction of unique patient-identifiable data could improve the quality of both registries by making matching of data possible.

Angioplasty, Balloon↗

Quality and variability of osteoporosis data in general practice computer records: implications for disease registers.

OBJECTIVE: To determine the extent to which routinely collected general practitioner computer data could be used to create disease registers of patients with osteoporosis, and to report any improvement in data quality since previous studies. STUDY DESIGN: Audit using anonymized data extracted from general practice computer records from across England. METHODS: Morbidity Query Information and Export Syntax (MIQUEST) software was used to extract structured data from the 78 volunteer practices that participated in the study. The data were aggregated and analysed. RESULTS: There were 100-fold differences in the rates of recording of relevant data. Many patients receiving treatment had no diagnostic codes. Data about secondary causes of osteoporosis and fractures were more consistently recorded than data relating to falls. There were no data to indicate whether fractures were low impact. T-scores, the gold-standard measure of bone density, were very infrequently recorded. CONCLUSIONS: Sufficient data about secondary causes of osteoporosis exist, and these could be searched to identify patients at risk. Meanwhile, fracture recoding could be improved, including likely fragility fractures, and T-scores could be added to computer records. A systematic approach is needed to raise the computer records to a standard where they can be used as valid and reliable disease registers.

Accidental Falls↗

Quality control in multicentric clinical trials. An experience of the EORTC Gynecological Cancer Cooperative Group.

Data Quality is a central requirement of scientific research and external monitoring is essential in multicentric clinical trials (MCT). A quality control (QC) study was conducted in the main Institutions participating in EORTC-GCCG Protocol number 55863 - randomised phase III trial of vindesine, cisplatin, bleomycin and mitomycin-C (BEMP) versus cisplatin (P) in disseminated squamous cell carcinoma of the uterine cervix - in order to assess the impact of variations in data quality on the conclusions of the trial. The reliability of the different centres in following the protocol was investigated by a questionnaire covering drug prescription, local facilities and the procedure for preparation and administration of chemotherapy. The 'treatment protocol adherence' was evaluated by recalculation of the ideal protocol dose and its comparison with the actual delivered dosage at each cycle of chemotherapy. 'Data quality control' was assessed by comparison of data on case report forms (CRFs) with the corresponding items in the medical records. Eleven centres participating in the trial were visited by the same team of reviewers. Striking differences were noted in the chemotherapy administration procedures and between the type and quality of hospital files. Overall, there was an acceptable level of data quality and protocol compliance. Data accuracy was 81.8% (range: 65. 6-97%) of the 4424 items checked. Incorrect data were found in 7.0% (2.3-14.5%), data were missing on the form in 3.6% of cases (0-12%) and data was on the form but not in the file in 7.6% of cases (0. 7-17.5%). Causes of inaccuracy were analysed. Both problems in data management but also in a lack of clarity of the protocol and/or CRFs were to blame. Training and supervision of data managers, precision in writing protocols, standardisation of some aspects of CRFs and the use of a checklist for chemotherapy data and treatment toxicities would have avoided many of these errors. The need for QC in all collaborative groups performing MCT is emphasised. A literature review on QC in MCT dealing with chemotherapy is included.

Antineoplastic Combined Chemotherapy Protocols↗

The quality of the quality indicator of pain derived from the minimum data set.

OBJECTIVE: To examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs). DATA SOURCE: Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Reporting data of 2000, Medicare Claims data of 2000 and the MDS of 2000-2002. STUDY DESIGN: Using the same assessment protocol, NH staff and study nurses independently assessed 3,469 nonhospice residents. Study nurses' assessments being gold standard, we quantified and compared quality of NH staff's pain rating across NHs with high, medium, or low hospice use. Multilevel models were built to assess the effect of NH hospice use levels on the occurrence of false positive (FP) and false negative (FN) errors in NH-rated "severe pain." PRINCIPAL FINDINGS: Of 178 NHs, 25 had medium and 41 high hospice use. NHs with higher hospice use had lower sensitivities. In multilevel analysis, we found a significant facility-level variation in the probability of FP and FN errors in facility-rated "severe pain." Resident characteristics only explained 4 and 0 percent of the facility variation in FP and FN, respectively; characteristics and locations (state) of NHs further explained 53 and 52 percent of the variance. After controlling for resident and NH characteristics, staff in NHs with medium or high hospice use were less likely to have FP or FN errors in their MDS documentation of pain than were staff in NHs with low or no hospice use. CONCLUSIONS: The examination of data quality of pooled MDS data from multiple NHs is insufficient. Multilevel analysis is needed to elucidate sources of heterogeneity in the quality of MDS data across NHs. Facility characteristics, e.g., hospice use or NH location, are systematically associated with overrated/underrated pain and may bias pain quality indicator (QI) comparisons. To ensure the integrity of QI comparison in the NH setting, the government may need to institute regular audits of MDS data quality.

Aged↗

XML-based visualization of design and completeness in medical databases.

PURPOSE: mdplot (medical database plot) visualizes both structure and quality of data in medical databases by means of a summary representation of design and completeness in XML format. The goal is to identify attributes suitable for evaluation and to aid in creating open data models. METHODS: A three-stage visualization approach is applied. First, an overview of all classes in a database, second a detailed view of a specific class and third an analysis of individual attributes. Missing data is identified to enable specific efforts to improve data quality prior to analysis. For each class number of patients, attributes, and records per patient are provided. A condensed bar chart for each category of attributes (categorical, numerical, text and other) visualizes available content: The abscissa corresponds to the sequence of attributes; the ordinate represents completeness per attribute. By selection of a specific class, a detailed description is provided including mean completeness in each category as well as completeness per attribute. To analyse attributes that are collected at several time points per patient, a frequency distribution of records per patient can be generated. RESULTS: The new methodology was applied to two clinical research databases consisting of 292 attributes (955 patients) and 224 attributes (610 patients), respectively, and resulted in major restructuring of the systems. A public website is provided for generation of mdplots.

Data Collection↗

A systematic comparison of three structure determination methods from NMR data: dependence upon quality and quantity of data.

We have systematically examined how the quality of NMR protein structures depends on (1) the number of NOE distance constraints, (2) their assumed precision, (3) the method of structure calculation and (4) the size of the protein. The test sets of distance constraints have been derived from the crystal structures of crambin (5 kDa) and staphylococcal nuclease (17 kDa). Three methods of structure calculation have been compared: Distance Geometry (DGEOM), Restrained Molecular Dynamics (XPLOR) and the Double Iterated Kalman Filter (DIKF). All three methods can reproduce the general features of the starting structure under all conditions tested. In many instances the apparent precision of the calculated structure (as measured by the RMS dispersion from the average) is greater than its accuracy (as measured by the RMS deviation of the average structure from the starting crystal structure). The global RMS deviations from the reference structures decrease exponentially as the number of constraints is increased, and after using about 30% of all potential constraints, the errors asymptotically approach a limiting value. Increasing the assumed precision of the constraints has the same qualitative effect as increasing the number of constraints. For comparable numbers of constraints/residue, the precision of the calculated structure is less for the larger than for the smaller protein, regardless of the method of calculation. The accuracy of the average structure calculated by Restrained Molecular Dynamics is greater than that of structures obtained by purely geometric methods (DGEOM and DIKF).

Magnetic Resonance Spectroscopy↗