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At least 469 records · Page 26Linked to original sources

PubMed2005

Electronic mail was not better than postal mail for surveying residents and faculty.

OBJECTIVE: To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. STUDY DESIGN AND SETTING: A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. RESULTS: For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. CONCLUSION: E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

Adult↗

PubMedDate not supplied

[The importance of data].

Decisions have to be made about what data on patient characteristics and processes and outcome need to be collected, and standard definitions of these data items need to be developed to identify data quality concerns as promptly as possible and to establish ways to improve data quality. The usefulness of any clinical database depends strongly on the quality of the collected data. If the data quality is poor, the results of studies using the database might be biased and unreliable. Furthermore, if the quality of the database has not been verified, the results might be given little credence, especially if they are unwelcome or unexpected. To assure the quality of clinical database is essential the clear definition of the uses to which the database is going to be put; the database should to be developed that is comprehensive in terms of its usefulness but limited in its size.

Databases, Factual↗

PubMed2005

Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement.

OBJECTIVE: To develop a framework for understanding factors affecting the use of patient survey data in quality improvement. DESIGN: Qualitative interviews with senior health professionals and managers and a review of the literature. SETTING: A quality improvement collaborative in Minnesota, USA involving teams from eight medical groups, focusing on how to use patient survey data to improve patient centred care. PARTICIPANTS: Eight team leaders (medical, clinical improvement or service quality directors) and six team members (clinical improvement coordinators and managers). RESULTS: Respondents reported three types of barriers before the collaborative: organisational, professional and data related. Organisational barriers included lack of supporting values for patient centred care, competing priorities, and lack of an effective quality improvement infrastructure. Professional barriers included clinicians and staff not being used to focusing on patient interaction as a quality issue, individuals not necessarily having been selected, trained or supported to provide patient centred care, and scepticism, defensiveness or resistance to change following feedback. Data related barriers included lack of expertise with survey data, lack of timely and specific results, uncertainty over the effective interventions or time frames for improvement, and consequent risk of perceived low cost effectiveness of data collection. Factors that appeared to have promoted data use included board led strategies to change culture and create quality improvement forums, leadership from senior physicians and managers, and the persistence of quality improvement staff over several years in demonstrating change in other areas. CONCLUSION: Using patient survey data may require a more concerted effort than for other clinical data. Organisations may need to develop cultures that support patient centred care, quality improvement capacity, and to align professional receptiveness and leadership with technical expertise with the data.

Data Collection↗

PubMedDate not supplied

Challenges of using medical insurance claims data for utilization analysis.

Research use of insurance claims data presents unique challenges and requires a series of value judgments that are intended to improve the data quality. In this study, medical insurance claims from 2 large companies were combined to assess utilization of complementary and alternative medicine. Challenges included assessing and improving the quality of data, combining data from 2 different companies with dissimilar coding systems, and determining the most appropriate ways to describe utilization. This article addresses 4 methodologic challenges in creating the analytic files: (1) conversion of claims into unique visits, (2) identification of incomplete claims data, (3) categorization of providers and locations of service, and (4) selecting the most useful measures of utilization and expenditures.

Female↗

PubMed2000

Forecasts using neural network versus Box-Jenkins methodology for ambient air quality monitoring data.

This study explores ambient air quality forecasts using the conventional time-series approach and a neural network. Sulfur dioxide and ozone monitoring data collected from two background stations and an industrial station are used. Various learning methods and varied numbers of hidden layer processing units of the neural network model are tested. Results obtained from the time-series and neural network models are discussed and compared on the basis of their performance for 1-step-ahead and 24-step-ahead forecasts. Although both models perform well for 1-step-ahead prediction, some neural network results reveal a slightly better forecast without manually adjusting model parameters, according to the results. For a 24-step-ahead forecast, most neural network results are as good as or superior to those of the time-series model. With the advantages of self-learning, self-adaptation, and parallel processing, the neural network approach is a promising technique for developing an automated short-term ambient air quality forecast system.

Air Pollution, Indoor↗

PubMed2004

What lies beneath?--issues in the representation of air quality management data for public consumption.

Policy developments in the UK and the European Union (EU) now require local authorities to engage the general public within the whole process of local air quality management (AQM). Indeed, this is considered to be one of the means by which air quality issues can gain public support and help ensure future improvements. One of the outcomes of this is that data sets associated with air quality management must now be disseminated to nonscientific audiences. This is a problematic task for a number of reasons. One of these relates to the fact that air quality data are complex and variable, yet the public demand representations that are clear and unambiguous. Another important issue is associated with the increasing use of geographical information systems (GIS) and mapping tools, which allow data to be generated and summarised in many different ways without due regard to the effects that the choice of methodology can have on the way data are interpreted. The variation in information obtained using different techniques can represent a problem, but is also an opportunity to further explore data sets and to draw out specific information for complementary air quality management tasks. However, at present, the lack of a well-grounded methodology and guidance for handling and representing the spatial aspects of data sets means that consistency between areas and authorities is not maintained. Such a situation fosters ambiguity at several levels, from the individual's perception of public health-related information to an Authority's rationale for the selection of air quality management areas (AQMAs). This paper investigates a number of issues relating to spatial data generation and representation in the field of air quality management, particularly in relation to emissions inventory data. The examples are UK based, but the issues raised are applicable to other examples and areas. One case study examines the difference in information gained through a number of common mapping techniques and shows how different 'problems' can be identified merely as an artefact of the dissemination technique itself. To further illustrate the difficulties and conflicts faced in representing and explaining these data in a practical context, reference is then also made to the methods recently considered by an example London authority. The paper concludes with a call for the development of a more standardised method for representing different types of air quality management-related data, which may help to overcome these problems in the future.

Air Pollutants↗

PubMedDate not supplied

Effects of errors in a multicenter medical study: preventing misinterpreted data.

Large research projects offer significant advantages for research, but they pose special data quality problems. Data gathered in such projects may contain a greater absolute number of mistakes because of the people collecting data, the complexity of data processing, and the collation required. We wanted to learn from the types and frequencies of errors encroaching on data in a multicenter field trial, and to assess the effects of these errors had they passed through. We used extensive error trapping while processing 688 forms from seven sites in the field trial. Snapshots of the dataset were taken at several points in the process, before and after checking and correcting. We discovered 2.4% of the received data to be mistaken. These errors would have affected the data's reliability, decisions based on the study, and possibly the choice of analysis. Almost all of the mistakes were made at the time of measurement and may be related to raters' perceived importance of the variables. We found that communication and education effectively reduced the number of mistakes and their impact on the study over the course of the field trial. While an estimate of the overall error rate is important, the number of mistakes, in general, is only imperfectly related to the errors' effects on the study's results. Our results also suggest that statistical models that treat mistakes as simple independent events can be misleading.

Bias↗

PubMed1994

Blood pressure measurement error: its effect on cross-sectional and trend analyses.

The measurement of blood pressure in epidemiological studies is difficult to standardize between centres in multi-centre studies and between repeat surveys over time. The use of standard mercury sphygmomanometers is common but especially prone to measurement error in terms of departure from the protocol and variation in measurement technique. Data from Australia's cardiovascular risk factor prevalence surveys on 21 independent populations, distributed geographically and temporally, has been examined to assess the effect of these errors on cross-sectional and trend analyses. The examination showed that last digit preference for zero may inflate estimates of proportions having high blood pressure. A tendency to record identical duplicate measurements could contribute 0.85 mmHg to time trends or geographic differences in mean systolic blood pressure (but not diastolic blood pressure). Epidemiological studies for geographic and trend differentials in systolic blood pressure need to be mindful of these effects in their analysis. There was some evidence of deterioration in data quality during data collection but no evidence that observers were influenced in their recording practice by observable respondents' characteristics. Training procedures for blood pressure measurement are of critical importance and adherence to the measurement protocol should be continuously monitored during data collection to ensure comparability of results.

Adult↗

PubMedDate not supplied

Ecological Monitoring and Assessment Network's proposed core monitoring variables: an early warning of environmental change.

This article reports on the evaluation of existing ecological monitoring variables from a variety of sources to select a suite of core variables suitable for monitoring at the Ecological Monitoring and Assessment Network (EMAN) sites located across Canada. The purpose of EMAN is to promote the acquisition of relevant and consistent data that can be used to report on national trends and provide an early warning of ecosystem change. Existing monitoring variables were evaluated in two steps. In the first step, three primary criteria were used to pre-screen preliminary variables. In the second step, a more detailed evaluation considered twenty criteria based on data quality, applicability, data collection methods, data analysis and interpretation, existing data and programs, and cost effectiveness to select a draft set of core monitoring variables (CMV). An ecological framework was developed to organize the CMV in a manner that permitted a gap analysis to confirm the CMV assessed a wide range of relevant environment components. The suite of CMV were then tested to determine their effectiveness in detecting ecosystem change caused by stressors with ecosystem responses that have been well documented in the literature. This project is part of a process lead by Environment Canada to select CMV to detect and track ecosystem change at EMAN sites. It is anticipated that the proposed CMV will undergo future discussion and development leading to the final selection of a suite of CMV for use at EMAN sites.

Biomarkers↗

PubMed2003

Experimental study design and grant writing in eight steps and 28 questions.

While writing a grant proposal may take a few days, the planning of the study takes much longer and requires thoughtful consideration. The use of a systematic and itemised approach can help in planning crucial details of a study. An eight-step, 28-question, iterative approach is proposed to help with the careful planning of experiments in order to maximise the researchers' chances of acceptance when submitting the study for funding and its results for publication. The steps include defining a relevant research question; selecting instrumentation, study design and statistics; determining sample size and sampling procedure; ensuring data quality throughout data collection and analysis; setting personnel and budget requirements, and writing a convincing grant proposal. Reviewers pay particular attention to the importance of the research topic and question, the presence of a clear problem statement and up to date review of the literature, the use of an optimal design and instrumentation, a sufficient and unbiased sample, and appropriate and well applied statistics. They also appreciate a clear and easy to follow proposal. The research question is the keystone of the entire enterprise, followed by the selection of an optimal study design and the control of possible confounding variables. No study is perfect. The researchers must constantly weigh advantages and disadvantages and select the most scientifically sound and feasible alternatives. While the steps and questions presented are best applied to experimental studies, the principles are also applicable to a wide range of questions and observational, evaluative and qualitative designs.

Guidelines as Topic↗

PubMed2000

Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review.

OBJECTIVE: To systematically review the peer-reviewed literature about the reliability and validity of chiropractic tests used to determine the need for spinal manipulative therapy of the lumbo-pelvic spine, taking into account the quality of the studies. DATA SOURCES: The CHIROLARS database was searched for the years 1976 to 1995 with the following index terms: "chiropractic tests," "chiropractic adjusting technique," "motion palpation," "movement palpation," "leg length," "applied kinesiology," and "sacrooccipital technique." In addition, a manual search was performed at the libraries of the Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark, and the Anglo-European College of Chiropractic, Bournemouth, United Kingdom. STUDY SELECTION: Studies pertaining to intraexaminer reliability, interexaminer reliability, and/or validity of chiropractic evaluation of the lumbo-pelvic spine were included. DATA EXTRACTION: Data quality were assessed independently by the two reviewers, with a quality score based on predefined methodologic criteria. Results of the studies were then evaluated in relation to quality. DATA SYNTHESIS: None of the tests studied had been sufficiently evaluated in relation to reliability and validity. Only tests for palpation for pain had consistently acceptable results. Motion palpation of the lumbar spine might be valid but showed poor reliability, whereas motion palpation of the sacroiliac joints seemed to be slightly reliable but was not shown to be valid. Measures of leg-length inequality seemed to correlate with radiographic measurements but consensus on method and interpretation is lacking. For the sacrooccipital technique, some evidence favors the validity of the arm-fossa test but the rest of the test regimen remains poorly documented. Documentation of applied kinesiology was not available. Palpation for muscle tension, palpation for misalignment, and visual inspection were either undocumented, unreliable, or not valid. CONCLUSION: The detection of the manipulative lesion in the lumbo-pelvic spine depends on valid and reliable tests. Because such tests have not been established, the presence of the manipulative lesion remains hypothetical. Great effort is needed to develop, establish, and enforce valid and reliable test procedures.

Chiropractic↗

PubMed1999

Cost analysis in the Department of Veterans Affairs: consensus and future directions.

OBJECTIVES: In 1997, the Management Decision and Research Center of the Department of Veterans Affairs convened cost experts and health economists in a working meeting. Its goal was to provide consensus guidelines for conducting cost analyses in managed care systems, such as VA, that do not have encounter-level cost data or that do not prepare itemized patient bills. The impetus for the meeting was that too often computer-based cost data were proposed or used in studies that were inappropriate for the question being addressed. There was also a sense that often great effort was being expended by VA health economists "reinventing the wheel" in developing new cost components for each study. METHODS: A group of 45 VA and non-VA health economists, health researchers, and policy-makers attended a 2 day working meeting organized around a series of case vignettes to identify areas of consensus, controversy, and gaps in knowledge. RESULTS: Consensus emerged in the following four areas: (1) Cost Methods. A "hybrid model" was identified as the current standard of cost analysis in VA and entails mixing "micro-costing" primary data collection and "gross-cost" computer-based methods to reflect resource-use variations that are essential to the research question. (2) Cost Infrastructure. VA is developing a new, but unevaluated, costing system that could allow for computer-based cost analyses at much finer levels of detail than is currently possible. (3) Data Quality. Ongoing data validation of existing and developing cost databases is needed, especially concerning interfacility variation. (4) Dissemination. A new cost data center was recommended to provide training, information dissemination, and coordination. CONCLUSIONS: Consensus was reached about the hybrid model as the current paradigm for cost analysis in systems like VA.

Costs and Cost Analysis↗

PubMedDate not supplied

CT scanner selection and specification for radiation therapy.

The underlying considerations necessary for selecting a CT scanner for radiation therapy treatment planning are analyzed and discussed. To obtain best value for funds expended it is desirable to compare CT scanner mechanical characteristics, data quality, and data handling capabilities. Specifications can be written to ensure prompt delivery of a unit containing all essential features without adding to the cost or complexity of the unit.

Humans↗

PubMed2000

Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome.

The aim of this study was to compare home polysomnography (HoPSG) with laboratory polysomnography (LabPSG) in the diagnosis of sleep apnea syndrome (SAS). A total of 103 patients referred for investigation of SAS underwent two full polysomnographies, using the portable Minisomno device at home and the Respisomnographe in the laboratory (both devices manufactured by the same company). Twenty percent of home-studied device polysomnography (HoSD-PSG) recordings and 5% of LabPSG recordings were excluded from analysis either because of lost data or poor quality data. Sleep stage distribution and subjective quality of sleep were similar by both methods. Using LabPSG, the mean (+/- SD) RDI was 25.7 (+/- 30.6) versus 22.8 (+/- 31.5) using HoSD-PSG (p > 0.05). Absolute differences between the home and laboratory respiratory disturbance index (RDI) were less than 10 for 65% of patients. Discordant RDIs (i.e., differences greater than 10) were observed for 63% of individuals with severe SAS (RDI > 30) versus 22% of those with normal or moderate SAS (RDI </= 30) (p < 0.05). Higher RDI differences were associated with poor airflow signal at home. Forty-seven percent of patients preferred LabPSG. Our results suggest that HoSD-PSG was not feasible for 33% of patients; there was no evidence of a better quality of sleep and recording tolerance at home; the reliability of HoSD-PSG for SAS diagnosis depends on the quality of data obtained under unattended conditions.

Adult↗

PubMed2005

Creating a bridge between data collection and program planning: a technical assistance model to maximize the use of HIV/AIDS surveillance and service utilization data for planning purposes.

Over time, improvements in HIV/AIDS surveillance and service utilization data have increased their usefulness for planning programs, targeting resources, and otherwise informing HIV/AIDS policy. However, community planning groups, service providers, and health department staff often have difficulty in interpreting and applying the wide array of data now available. We describe the development of the Bridging Model, a technical assistance model for overcoming barriers to the use of data for program planning. Through the use of an iterative feedback loop in the model, HIV/AIDS data products constantly are evolving to better inform the decision-making tasks of their multiple users. Implementation of this model has led to improved data quality and data products and to a greater willingness and ability among stakeholders to use the data for planning purposes.

Data Collection↗

PubMed2001

Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program.

OBJECTIVES: This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya. METHODS: Health clinic data, quality control data, and costs were analyzed. RESULTS: The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112. CONCLUSIONS: The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.

Cost-Benefit Analysis↗

PubMed2004

Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

Computer Communication Networks↗

PubMed1990

Adjuvant chemotherapy for gastric cancer in Japan: present status and suggestions for rational clinical trials.

A review of the present status of adjuvant chemotherapy for gastric cancer in Japan has been made. The single use of mitomycin C (MMC) after curative gastrectomy, a multidrug combination of MMC, 5-fluorouracil (5FU) and cytosine arabinoside (CA) (MFC therapy), and a combination of inductive MFC followed by maintenance 5FU in an adjuvant setting have proved beneficial in subsets of moderately locally advanced diseases. The advantages of the Japanese trials seem to be attributable to perioperative chemotherapy with MMC and/or 5FU, obviously given in less amounts than in other countries, against minimum residual tumors following surgery. Effort should be directed, however, to improving the quality of data, at present biased by a number of exclusions and drop-outs which should not be considered negligible. The author mentions the beneficial use of a computer-assisted randomization system for avoiding the violation of entry criteria, and of controlling data quality with individual dose intensity (I.D.I.) and relative performance (R.P.) indices. Prerequisites for success in the adjuvant chemotherapy's clinical trial included planning effective regimens, proper selection of subjects and faithful performance of proposed regimens.

Antineoplastic Combined Chemotherapy Protocols↗