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PubMed1985

Health care machine-readable data files: secondary analysis, access, and the role of the library.

Access to health care machine-readable data files (MRDF) is becoming increasingly important to students and researchers in the health care field who use the data in secondary analysis. Health sciences libraries must play a role in providing such access, and this role should consist primarily in providing users with information about the identity and contents of available MRDF and about how they may be obtained. Libraries should therefore collect extensive materials containing information about the MRDF that may be of interest to their users. Many such materials are available in print, and their quality may be expected to improve as newly developed methods and procedures for constructing bibliographic citations, abstracts, and catalog entries for MRDF are put into practice. Also, it is now feasible to incorporate data file abstracts into existing online bibliographic databases.

Health Services Research↗

PubMed2003

Setting standards based on patients' views on access and continuity: secondary analysis of data from the general practice assessment survey.

OBJECTIVES: To examine patients' views on access and continuity in general practice to derive quality standards. DESIGN: Secondary analysis of data from general practice research studies and routine quality assessment activities undertaken by practices and primary care trusts. SETTING: General practice. PARTICIPANTS: General practice patients. RESULTS: Satisfactory standards of access were next day appointments with general practitioners and a 6-10 minute wait for consultations to begin. A satisfactory level of continuity was seeing the same general practitioner "a lot of the time." Standards varied with the analytic method used and by sociodemographic group. CONCLUSIONS: Standards expected by patients in primary care can be derived from linked report-assessment pairs. Patients may have expectations of access that are in excess of government targets. Patients also have high expectations of continuity of care. It is unclear the degree to which such standards are reliable or valid, how conflicts between access and continuity should be resolved, or how these standards relate to other priorities of patients such as high quality interpersonal care.

Adolescent↗

PubMed2001

Treating the substance-abusing suicidal patient.

Studies concerning the treatment of substance-abusing suicidal patients are scarce despite the frequent presence of suicidal behavior among this population. Indeed, suicidality (ideation or behavior) is generally an exclusion criterion for participation in treatment studies of subjects with alcohol or drug abuse. Consequently, to date, little is known about the optimal treatment of this population. The first study involving substance-abusing suicidal patients was an open-label trial conducted in the early 1990s. This study involved 12 patients, all of whom demonstrated recent suicidal ideations and had made a lifetime suicide attempt. The results of that open-label study demonstrated significant within-group improvement in both depressive symptoms (including suicidal ideations) and level of drinking. However, substantial residual depressive symptoms and drinking persisted at the end of the trial. Also, because no placebo control group was utilized, the authors of that study could not rule out the possibility that the apparent therapeutic effect from fluoxetine was the result of the placebo effect. To date, only one double-blind, placebo-controlled study of subjects with alcohol or substance abuse has included substantial numbers of suicidal patients. The study involved 51 subjects, of whom 20 (39%) had made a suicide attempt in the current depressive episode, 31 (61%) had made a suicide attempt in their lifetime, and 46 (90%) had reported suicidal ideations in the week before hospitalization. The results of that double-blind, placebo-controlled study suggest that fluoxetine was effective in decreasing but not eliminating both the depressive symptoms (including suicidal ideations) and the level of alcohol consumption among a study group of subjects with comorbid major depressive disorder and alcohol dependence, many of whom displayed suicidal ideations. A secondary data analysis from that study suggested that cigarette smoking is also significantly decreased by fluoxetine, but the magnitude of the decrease is limited and few of these patients totally quit smoking with fluoxetine treatment alone. Another secondary data analysis from that study suggested that marijuana smoking was also significantly decreased in a subgroup of subjects who demonstrated cannabis abuse and that the magnitude of this improvement was robust. A third secondary data analysis from that study suggested that cocaine abuse acts as a predictor of poor outcome for both depressive symptoms (including suicidality) and level of alcohol use in this population. The results of a 1-year naturalistic follow-up study involving the patients from that study suggest that the benefits of fluoxetine in decreasing depressive symptoms and level of drinking persist 1 year after entering the treatment program. To date, no other double-blind, placebo-controlled studies involving substantial numbers of substance-abusing suicidal patients have been reported to either confirm or refute these findings. Further studies are clearly warranted to evaluate the efficacy of various pharmacotherapeutic agents and various psychotherapies in the treatment of substance-abusing suicidal patients.

Adult↗

PubMed2006

A cross-sectional study of hypertension in an elderly population (75 years and over) with atrial fibrillation: secondary analysis of data from the Birmingham Atrial Fibrillation in the Aged (BAFTA) randomised controlled trial.

BACKGROUND: Atrial fibrillation and hypertension are two common conditions in the elderly, associated with significant morbidity and mortality. Little information is available regarding the epidemiology of hypertension in elderly patients with atrial fibrillation. SUBJECTS AND METHODS: A secondary analysis of data from the Birmingham Atrial Fibrillation Treatment of the Aged study, a randomised controlled trial of thrombo-prophylaxis in atrial fibrillation in a primary care population. The study population comprised patients aged 75 and over with electrocardiogram (ECG) confirmed atrial fibrillation. Blood pressure was recorded in the general practice surgery on two occasions using standardised methods. History of hypertension was sought from the medical records and from asking the patient. RESULTS: 3059 subjects had ECG confirmed atrial fibrillation. The prevalence of a history of hypertension in this group was 57.5%. The mean systolic blood pressure was 141 mmHg (standard deviation: 21 mmHg) in men and 144 mmHg (22 mmHg) in women. The mean diastolic blood pressure was 79 mmHg (12 mmHg) in men and 80 mmHg in women (12 mmHg). The mean systolic blood pressure was slightly lower than that of the general population aged 75 and over, but the mean diastolic blood pressure was significantly higher in patients in atrial fibrillation (by 8 mmHg). Among the patients with a diagnosis of hypertension, 86.5% were on blood pressure lowering medications. CONCLUSIONS: Hypertension is more commonly diagnosed in older patients with atrial fibrillation than in the general population. The mean systolic blood pressure is slightly lower, but the mean diastolic blood pressure substantially higher in older patients in atrial fibrillation, compared to the general population.

Aged↗

PubMed2000

Frequency of intravenous medication administration to hospitalised patients: secondary data-analysis of the Belgian nursing minimum data set.

The purpose of this study was to investigate the frequency of intravenous medication administration with Belgian hospitalised patients. Factors, which might influence this frequency of administration, were also studied. Research questions were investigated by secondary data-analysis of the Belgian Nursing Minimum Data Set. The randomised sample consisted of 1,035,681 observations on 421,530 patients. Results of this study demonstrate that one out of three (34%) hospitalised patients received intravenous medication. Medical diagnoses, for which most intravenous medications were administered, were oncological diseases: myeloid (77.9%) and lymphoid (69.4%) leukaemia. Elderly (6.7%) and female (31.2%) patients received significantly less intravenous medication than respectively young (32.9%) (chi(2) = 98411, df = 1, p<0.001) and male (38%) (chi(2) = 2033, df = 1, p<0.001) patients. Patients with intravenous medication administration were labour intensive for nursing staff.

Adolescent↗

PubMed2002

Neighbourhood socioeconomic context and self reported health and smoking: a secondary analysis of data on seven cities.

OBJECTIVE: Many studies have shown that poor health status and harmful health behaviour occur more frequently in deprived neighbourhoods. Most studies show modest associations between area level socioeconomic factors, the neighbourhood context, and health outcomes. However, estimates for the contextual effects vary. It is unclear if this variation is attributable to differences in methodology. This study examines whether contextual neighbourhood differences in health outcomes really vary between cities or that differences in methodology may account for these differences. DESIGN: Secondary analysis of data from health interview surveys in seven large Dutch cities in the 1990s comprising 23 269 residents of 484 neighbourhoods, using multilevel logistic models. SETTING: General population aged 16 and over. MAIN OUTCOME MEASURES: Self reported health, smoking of cigarettes. MAIN RESULTS: The socioeconomic context of neighbourhoods is associated with health outcomes in all large Dutch cities. The strength of the association varies between cities, but variation is much smaller in the age group 25-64. Furthermore, neighbourhood differences vary in size between native and other residents. Contextual neighbourhood differences are about two times larger for self reported health than for the smoking of cigarettes, but for native Dutch people they are of similar size. CONCLUSIONS: A comparatively large improvement in health may be gained in deprived neighbourhoods, because of the poorer health status to which the context of these neighbourhoods also contributes. Health promoting interventions should be aimed at the residents and at the context of deprived neighbourhoods, taking differences between ethnic groups and age groups into account.

Adolescent↗

PubMed1991

When plagiarism becomes research.

There are three possible levels of analysis in clinical research. Primary analysis deals with the original analysis of research study data. Secondary analysis is a reanalysis of the original data, either to address the original question through better techniques or to address a new question using old data. Meta-analysis is a statistical analysis of many studies done to summarize a body of literature. Meta-analysis is particularly helpful in an area in which original research studies have produced conflicting results because it enables analysis of the impact of study characteristics upon the end result. The family practitioner as a consumer of research needs to become familiar with the technique of meta-analysis because it is appearing with increasing frequency in the medical literature. Still somewhat controversial, meta-analysis requires a rigorous approach to ensure its validity: this editorial is written to assist the family practitioner in an understanding of the meta-analytic technique and point out important features that need to appear in any published meta-analysis.

Bias↗

PubMed2001

Antibiotic prescribing by single handed general practitioners: secondary analysis of data.

AIM: To determine the contribution of various doctor and patient factors on the frequency of antibiotic prescribing. METHODS: Secondary analyses of data on 155 single handed general practitioners. RESULTS: Three variables explained 25% of variation in antibiotic prescribing. Doctors qualified from the Indian subcontinent issued more antibiotics than U.K.-qualified doctors. Patients from the non-manual social class were issued fewer antibiotics than those from the manual class and the most deprived patients received significantly more antibiotics. CONCLUSION: Very little of prescribing of antibiotics by doctors is explained by these doctor-patient factors. Prescribing is a complex process and the search for factors must continue in order to address the rising antibiotic resistance.

Anti-Bacterial Agents↗

PubMedDate not supplied

Methodological considerations with secondary analyses.

The use of secondary data sets has begun to receive increased attention in nursing research. Shrinking grant dollars, continuing pressure to produce replicable generalizable research results, and a growing interest in outcomes management and research have all contributed to an interest in examining how data may be used for multiple purposes. Secondary data analysis may offer the practitioner and researcher ready access to large data sets with multiple variables; yet, there are potentially significant methodological concerns that should be well understood and managed in the initial query design. Considered here will be some of the issues regarding the reliability and validity of large data sets used for secondary analysis, including a discussion on maintaining the integrity of those files as they are moved, merged, and transformed. Finally, methods for managing missing data are reviewed.

Abstracting and Indexing↗

PubMedDate not supplied

Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE: As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. METHOD: The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. RESULT: The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). CONCLUSION: Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

Accreditation↗

PubMed2003

Specialist palliative care: patients' experiences.

BACKGROUND: Nursing research generally, and palliative care research in particular, has been criticized for generating numerous small scale, often qualitative and/or evaluative studies, from which it is difficult to draw generalizations. AIMS: Our aim in this study was to conduct a synthesis of three evaluative studies of palliative care services in the United Kingdom (UK), to ascertain patients' reported expectations and experiences of specialist care. We also demonstrate how secondary data analysis and synthesis can identify commonalities and differences between services. METHODS: Secondary qualitative data analysis was conducted on interview data gathered from 37 patients during three evaluation studies of specialist palliative care services. All studies used formative evaluation methodology. FINDINGS: Four themes were identified: (1) knowledge and information about services, (2) meeting practical and psychosocial needs, (3) lack of control, and (4) family atmosphere. Data are presented to illustrate the presence or absence of these themes in patients' accounts of their expectations and experiences of each service. STUDY LIMITATIONS: Data were collected at different times between 1998 and 2000, and interviews were conducted by different researchers. CONCLUSIONS: Synthesizing findings from small scale qualitative studies offers the possibility of demonstrating their applicability beyond local and specific contexts. It is imperative to listen to the experiences of patients and carers as a basis for developing interventions and guidelines for services. The methods proposed in this paper offer the potential for these voices of experience to be heard more widely.

Evaluation Studies as Topic↗

PubMed2000

Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data.

OBJECTIVE: This study was carried out to determine the effect of a range of socio-economic features on frequent attendance in general practice from a large database of general practice consultations using two definitions of frequent attendance. METHODS: Secondary analyses were carried out of data from the Fourth National Survey of Morbidity in General Practice covering 60 general practices in England and Wales. A total of 283 842 adult patients and their consultations between September 1991 and August 1992 were examined. The main outcome measure was the odds ratio of being a frequent attender (95% confidence intervals). RESULTS: Using a definition of 12+ consultations/year, men were less likely to be frequent attenders (OR 0.14, 95% CI 0.13-0.17); however, the difference between men and women lessens with age. Patients who were more likely to be frequent attenders included those who were divorced or widowed (1.41, 1.31-1.51); from social classes IIIM (1.23, 1.17-1.29) and IV/V (1.33, 1.26-1.41); South Asian people (1.38, 1.16-1.65); or unemployed (1.61, 1.46-1.77). Other factors signifying isolation or poverty were also linked to frequent attendance. Using the definition of '6+ consultations for minor problems' produced broadly similar results although the relative weight of the factors showed some differences. CONCLUSIONS: Socio-economic factors were important indicators of frequent attendance in general practice. Results were very similar using either definition, suggesting that both are valid for further work. Furthermore, frequent attendance is a complex process associated with many factors outside the control of the GP.

Adolescent↗

PubMed2004

Asian/Pacific Islander American women: age and death rates during hospitalization for breast cancer.

PURPOSE/OBJECTIVES: To investigate whether differences in age and death rates exist between hospitalized Asian/Pacific Islander American (APIA) women and women of other racial groups. DESIGN: Secondary data analysis of a national data set. SETTING: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data on women with breast cancer based on racial status. A total of 20,507 hospitalization records met the study criteria. SAMPLE: All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization. METHODS: Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups. FINDINGS: Significant differences were found between APIA and Caucasian and Latino women. Significant differences based on race were found between subjects who had died during hospitalization. On average, APIA women were the youngest to die. CONCLUSIONS: APIA women with breast cancer were among the youngest women being hospitalized and the youngest to die during hospitalization. IMPLICATIONS FOR NURSING: Cultural awareness by nurses is critical when discussing methods for prevention and early detection of breast cancer with minority women. Targeting new immigrants is a priority for those who screen and educate women about detection and treatment of breast cancer.

Adult↗

PubMed1997

Using national data sets on CD-ROM to teach nursing research.

PURPOSE: To explore the use of national data sets on CD-ROM for teaching graduate nursing research. SIGNIFICANCE: Secondary data analysis of national health data sets is economical and provides a useful experience for students learning research. SCOPE: The advantages and disadvantages of using national health data sets on CD-ROM are described. Students in three majors in nursing worked in groups to address research questions that could be answered using variables in the National Health Interview Survey. Several computer laboratory sessions were held to teach students how to extract the data and apply SPSS to analyze data. FINDINGS: The pilot program was a success, but not without problems. Ten steps to ensure better attainment of objectives were formulated. CONCLUSIONS: National data sets on CD-ROM are an inexpensive, rich data source that allow flexibility for students and faculty. Secondary data analysis using national health data sets is an underused approach in nursing. Graduate students can have a significant research experience while curbing the costs-to organizations and themselves-associated with primary data collection.

CD-ROM↗

PubMed2026

Relationships between cannabis and cocaine use in a randomized trial of combined buprenorphine and naltrexone for DSM-IV cocaine dependence.

BACKGROUND: Cannabis is the most commonly used drug in the United States, and among people who use cannabis, polysubstance use is common and understudied. We aimed to examine the association of tetrahydrocannabinol (THC) positive urine drug screen (+UDS) with the odds of submitting a cocaine + UDS during cocaine use disorder treatment. METHODS: We conducted a secondary data analysis of a previously reported double-blind, placebo-controlled clinical trial, CTN0048. Participants meeting criteria for opioid abuse/dependence were assigned to receive extended-release naltrexone and one of three conditions of buprenorphine (placebo, 4 mg/day, 16 mg/day) for 8 weeks. Generalized estimating equations (GEE) were used to analyze urine samples (Liu et al., 2018) collected over time, examining the association between THC + UDS and cocaine + UDS during treatment. RESULTS: Participants (n = 301) averaged 46 (SD = 8.64) years of age, were majority male (78.41 %), non-Hispanic (89.70 %), and African American (66.45 %). GEE results indicated that patients who submitted THC + UDS had significantly higher odds of submitting cocaine + UDS compared to participants who submitted THC-negative UDS across the 25 time points examined (OR = 1.47, 95 % CI = 1.21-1.79, p = 0.00). Time (OR = 0.9998, 95 % CI: 0.9997, 0.9999, p = 0.018) and the covariate of sex assigned at birth (OR = 1.77, 95 % CI = 1.13-2.77, p = 0.013) were also significant in the model, indicating very small decreases in the odds of submitting a cocaine + UDS over time for all patients and 77 % higher odds of submitting cocaine + UDS for females. CONCLUSION: THC + UDS was associated with increased odds of submitting a cocaine + UDS during treatment. Further investigation is needed to discern whether decreasing THC use will result in reduced cocaine use; however, these results suggest that it may be beneficial to counsel patients on cannabis use cessation both before and during treatment for cocaine use, as it is related to cocaine use treatment outcomes. TRIAL REGISTRATION: Secondary data analysis of ClinicalTrials.gov, TRN: NCT01402492 ("A randomized study to test the safety and effectiveness of buprenorphine in the presence of naltrexone for the treatment of cocaine dependence"; National Drug Abuse Treatment Clinical Trials Network (CTN) clinical trial: CTN0048), Registration date: 27 July 2011.

Humans↗

PubMed1988

Social networks and the functional health status of the poor: a secondary analysis of data from the National Survey of Personal Health Practices and Consequences.

This study uses data from the Wave I of the National Survey of Personal Health Practices and Consequences (N = 3025) to examine the relationship between social networks and the health status of the poor. No single category of networks was found to be consistently predictive of health status among the poor. The number of close friends, satisfaction with number of close ties, frequency of contact with network ties and church attendance were all significantly related to health status, but in no case were sufficient to bring health status levels of the poor up to the level of the nonpoor.

Adult↗

PubMed1998

[Speed of information processing and fluid intelligence in advanced age. A secondary analysis of data of the Bonn Longitudinal Study of Aging based on "latent growth curve models"].

According to the "speed"-hypothesis of cognitive development, the slowing of information processing in old age is at the core of negative age differences in psychometric intelligence. The present study investigates the "speed"-hypothesis for fluid intelligence at the individual level using Latent Growth Curve Methodology. Data on 4 measurement points come from the Bonn Longitudinal Study of aging (N = 127, mean age 67.2, 53% women). Based on principal factor analysis, markers of mental speed were the WAIS Digit Symbol Test and a simple psychomotor task. As indicators of fluid intelligence the WAIS Object Assembly and Block Design were used. After separately fitting Latent Growth Curve Models for the trajectory of mental speed and fluid intelligence, a combined model showed no statistically significant improvement of fit for freeing the covariance between the two slope-factors. Interpreting this result, contrary to the "speed"-hypothesis the intraindividual change of fluid intelligence does not relate to the according change of mental speed.

Aged↗

PubMedDate not supplied

Secondary analysis of data.

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Data Collection↗