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PubMed2005

The use of NHS accident and emergency services by commercial sea fishermen in the North East of Scotland.

BACKGROUND: Commercial sea fishing is known to be a hazardous occupation, but little quantitative research has been conducted in the UK. OBJECTIVE: To describe the demography of commercial fishermen accessing NHS accident and emergency (A&E) services and profile the reasons for attendance. METHODS: Eight NHS A&E departments in North East Scotland participated in the audit. A structured data collection form was completed by the attending nurse or doctor during a 6 month period (March-August). All commercial sea fishermen attending during this time were included whether or not the reason for attendance was work-related. RESULTS: There were 164 cases of which 133 (81%) presented with injuries and 19 (12%) with illnesses (12 unknown). Twenty-seven (16%) cases had required emergency evacuation from commercial vessels. The most frequent category of injury was 'hand', 'wrist' or 'finger' followed by 'head', 'face' and 'throat'. CONCLUSION: Commercial sea fishing is a dangerous occupation with many injuries requiring NHS A&E treatment. The relatively high level of injuries compared to illness indicates that there are still safety issues to be addressed and current risk assessment requirements need to be reviewed.

Accidents, Occupational↗

PubMed2005

Usage of troponin in the real world: a lesson for the introduction of biochemical assays.

BACKGROUND: Studies have demonstrated economic and clinical effectiveness using troponin as a risk stratification tool in chest pain patients. Those with a positive result are investigated invasively, whilst those with a negative result and ECG are promptly mobilized, facilitating discharge. AIM: To determine whether our use of troponin I (cTnI) in routine clinical practice conforms to ideal standards. DESIGN: Audit study. METHODS: Data were collected from 93 laboratory request forms for cTnI measurement on 72 patients with matched available patient records. RESULTS: Eighty requests had no information regarding timing of blood sample in relation to the clinical event; 39% gave no clinical indication. Only 71% of results were available within 12 h. An admission diagnosis of acute coronary syndrome (ACS) was made in 25%. Fifteen had typical cardiac chest pain with a negative cTnI: 6 of these had an exercise treadmill test before discharge. Nine had a positive cTnI, but only two had coronary angiography. Of patients with negative cTnI and possible ACS, 84% were in hospital for >4 days. DISCUSSION: The introduction of troponin assays into widespread use requires careful assessment. cTnI requests and subsequent patient management remain below expected standards. Ideally, the laboratory should provide an accurate result within a reasonable time frame, while physicians need to request cTnI at a suitable time-point and use the result appropriately. Lessons from the introduction of cTnI measurement may be useful for the introduction of future new tests in other areas of cardiology and medicine.

Biomarkers↗

PubMed2001

Variation in speech perception scores among children with cochlear implants.

OBJECTIVE: The objective of this study was to identify common factors affecting speech perception scores in children with cochlear implants. DESIGN: Speech perception data for 167 implanted children were collected at two cochlear implant centres in Melbourne and Sydney. The data comprised audition-alone scores on open-set word and sentence tests. Children were selected on the basis that they had a Nucleus 22-electrode cochlear implant. The average age of the children was 5 yr. Information was also collected about 12 factors that may have influenced speech perception scores for each child. Analysis of covariance was used to identify factors that significantly affected speech perception scores. Pearson pairwise correlation coefficients were also calculated for all factors analyzed. RESULTS: The analyses in this study identified factors that accounted for 51%, 34%, and 45% of the variance in phoneme, word and sentence perception scores. Scores decreased by 1.4 to 2.4% per year of profound deafness prior to implantation. Children who normally use oral communication scored significantly higher than children normally using sign or simultaneous oral and sign communication. Children implanted in Sydney scored higher on average than children implanted in Melbourne. CONCLUSIONS: The results show that a significant part of the variation in speech perception scores is systematically related to audiological and environmental factors for each child. The reasons for significant differences between children using different communication modes or from different clinics were not identified.

Adolescent↗

PubMed2006

Orthogonal search-based rule extraction for modelling the decision to transfuse.

Data from an audit relating to transfusion decisions during intermediate or major surgery were analysed to determine the strengths of certain factors in the decision making process. The analysis, using orthogonal search-based rule extraction (OSRE) from a trained neural network, demonstrated that the risk of tissue hypoxia (ROTH) assessed using a 100-mm visual analogue scale, the haemoglobin value (Hb) and the presence or absence of on-going haemorrhage (OGH) were able to reproduce the transfusion decisions with a joint specificity of 0.96 and sensitivity of 0.93 and a positive predictive value of 0.9. The rules indicating transfusion were: 1. ROTH > 32 mm and Hb < 94 g x l(-1); 2. ROTH > 13 mm and Hb < 87 g x l(-1); 3. ROTH > 38 mm, Hb < 102 g x l(-1) and OGH; 4. Hb < 78 g x l(-1).

Blood Loss, Surgical↗

PubMed2006

Development of permanent national register of blood component use utilizing electronic hospital information systems.

BACKGROUND AND OBJECTIVES: We wanted to establish a permanent national database system, which can be utilized to study transfusion recipients and blood use in Finland. MATERIALS AND METHODS: A regularly updated register for permanent use was developed. To study the usability of the database, years 2002 and 2003 were further analysed. Database included all transfused patients in major blood-transfusing hospitals from four university and five central hospital districts managing altogether 63% of Finnish inpatient hospital episodes. RESULTS: Audit of gathered data reveal 96.8% match in adult blood components with Finnish Red Cross, Blood Service sales figures. Model data set includes 59,535 transfused patients (44.3% men and 55.7% women) having received 529,104 blood components. Half of all blood units were transfused in connection with surgical operations. Most of the blood recipients were elderly (51.6% are over 64 years of age). Blood-component use and transfusion-related costs varied widely between hospitals. CONCLUSION: Hospital data managing systems can be useful for creating a population-based database system to monitor and compare transfusion practices. This record provides information about transfusion epidemiology for transfusion professionals, hospital management, and hospital administration.

Adolescent↗

PubMed1994

The role of general practitioners in diabetic eye care in Lanarkshire.

This study reports data from 50 practices (3550 patients) in Lanarkshire taking part in an audit of diabetes care. Data were obtained by review of general practitioner records and the correspondence from consultants and opticians contained in them. The principal study measures examine the process of care. Overall levels of performance were low: only 35.5% of patients had visual acuity and 54.5% fundoscopy recorded in the previous year. Significantly better results were observed for both examinations in those few practices which performed these examinations in more than 10% of their patients (51.4% vs 32.0% (mean difference 19.4, 95% CI 16.1-23.7) for visual acuity and 65.7% vs 53.3% (mean difference 12.4, 95% CI 3.0-21.8) for fundoscopy. Less than half of diabetic patients in Lanarkshire currently receive adequate screening for the ocular complications of diabetes. Most practices rely on hospital diabetic and ophthalmology services. Where practices undertake ocular examination of patients, this is currently in addition to those services provided elsewhere.

Diabetes Mellitus↗

PubMed2004

Accuracy of nursing home medical record information about care-process delivery: implications for staff management and improvement.

Arguments have been made that the culture of nursing homes (NHs) must change to improve the quality of care, and two initiatives have been designed to accomplish this goal. One initiative is to provide resident outcome information (quality indicators) to NH management and consumers via public reporting systems. This initiative is based on the assumptions that resident outcomes are related to care processes implemented by NH staff, the NH industry will respond to market forces, and there are management systems in place within NHs to change the behavior of direct care staff if outcomes are poor. A separate staffing initiative argues that NH care will not improve until there are resources available to increase the number of direct care staff and improve staff training. This initiative also assumes that systems are in place to manage staff resources. Unfortunately, these initiatives may have limited efficacy because information useful for managing the behavior of direct care providers is unavailable within NHs. Medical record documentation about daily care-process implementation may be so erroneous that even the best-intentioned efforts to improve the care received by residents will not be successful. A culture of inaccurate documentation is largely created by a discrepancy between care expectations placed on NHs by regulatory guidelines and inadequate reimbursement to fulfill these expectations. Nursing home staff have little incentive to implement the technologies necessary to audit and assure data quality if accurate documentation reveals that care consistent with regulatory guidelines is not or cannot be provided. A survey process that largely focuses on chart documentation to assess quality provides further incentive for care-process documentation as opposed to care-process delivery. This article reviews methods to improve the accuracy of NH medical record documentation and to create data systems useful for staff training and management.

Aged↗

PubMed1981

Surgical audit.

Explore the source record for details and available documents.

Data Collection↗

PubMed1991

Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy.

(1) Safety and monitoring should be part of a quality assurance programme for endoscopy units. (2) Resuscitation equipment and drugs must be available in the endoscopy and recovery areas. (3) Staff of all grades and disciplines should be familiar with resuscitation methods and undergo periodic retraining. (4) Equipment and drugs necessary for the maintenance of airway, breathing, and circulation should be present in the endoscopy unit and recovery area (if outside the unit) and checked regularly. (5) A qualified nurse, trained in endoscopic techniques and adequately trained in resuscitation techniques, should monitor the patient's condition during procedures. (6) Before endoscopy, adverse risk factors should be identified. This may be aided by the use of a check list. (7) The dosage of all drugs should be kept to the minimum necessary. There is evidence that benzodiazepine/opioid mixtures are hazardous. (8) Specific antagonists for benzodiazepines and opioids exist and should be available in the event of emergency. (9) A cannula should be placed in a vein during endoscopy on 'at risk' patients. (10) Oxygen enriched air should be given to 'at risk' patients undergoing endoscopic procedures. (11) The endoscopist should ensure the well being and clinical observation of the patient undergoing endoscopy in conjunction with another individual. This individual should be a qualified nurse trained in endoscopic techniques or another medically qualified practitioner. (12) Monitoring techniques such as pulse oximetry are recommended. (13) Clinical monitoring of the patient must be continued into the recovery area. (14) Records of management and outcome should be collected and will provide data for appropriate audit.

Anesthesia Recovery Period↗

PubMed1995

Permanent pacemaker practice at a Scottish district general hospital between 1987 and 1993.

BACKGROUND: Raigmore is a district general hospital offering a permanent pacemaker service to its catchment population of 233,500. It has been argued that the British public would be better served by a less centralised pacing service. There also exists the view, however, that a lower rate of complications and best follow up practice are achieved by specialised centres. The pacemaker practice over a 79 month period (January 1987 to July 1993) was thus reviewed with these issues in mind. METHODS: The pacemaker records of all new implantations for the period under observation were reviewed retrospectively. Data were acquired under the headings age, sex, symptoms, electrocardiographic (ECG) indications, and complications (early and late). Comparison was made with United Kingdom national data, a previous audit from Raigmore, and two recently published large series from specialist centres (one British and the other French). RESULTS: The mean age of patients who underwent implantation was 74 years and 47.5% were male. The most common presenting symptoms were syncope (46%), dizzy spells (24.5%), and heart failure (11.5%). The most common ECG indications for pacing were complete heart block (wide QRS) (28%), atrial flutter/fibrillation with bradycardia (21.6%) and complete heart block (narrow QRS) (9.6%). The implantation rate was 184/million population/year in 1993. The early and late complication rates were low (2.48%). CONCLUSIONS: The presence of a pacing centre in a remote part of the United Kingdom fulfils a necessary service and has low complication rates, with implantation rates and patterns that are comparable with those in other parts of the country.

Adult↗

PubMed2004

Monitoring mortality in general practice in Grampian, Scotland.

Information on the distribution of mortality and morbidity in general practice is scarce, and not easily accessible either by health authorities or individual general practices. Although the assessment of population mortality is a standard public health measure, colleagues in public health, information sciences and general practice rarely undertake such activity related to general practice populations. Mortality information can be used for various purposes. Examples are providing background data for clinical audits or alerting practitioners to quality issues in the healthcare industry or even suggesting environmental hazards. We measured the experience of mortality in all generally practices in Grampian in the years 1991 to 1999. All practices were notified of their actual and expected mortality over this period of time and asked for comment. Only three general practices had excess mortality experience in both the periods 1991 to 1995 and 1996 to 1999. Only a minority of practices commented on the results. It appears that a high presence of nursing homes in a practice might skew the results; this phenomenon will be central to further inquiry. Future methodology for recording death in general practice should take account of this, as well as providing an account of the qualitative aspects of patients' need for a dignified satisfactory death.

Adolescent↗

PubMed1995

Construction of a community height surveillance programme: the Hackney growth initiative.

OBJECTIVES: To determine why, in the London Borough of Hackney before 1990, fewer children than expected were identified with remedial causes of short stature. To construct a practical model for height surveillance of 5 and 11 year old school entrants to improve the quality of child growth surveillance. SETTING: City and Hackney Borough, London, United Kingdom. METHODS: School nurses were trained by a clinical auxologist to measure children's height at school entry accurately and reproducibly. New procedures for measurement technique, plotting of data, referral, and audit were established. A reference manual was provided and a continuing training programme was started. RESULTS: During the first year the percentage of the target group measured was low. Changes in work practice led to improvements from 77% measured in the first year to 91% in the second year and 87% in the third year for 5 year olds. Improvements for 11 year olds were from 36% to 86% to 87% over the three years. Only 1.2% of 5 year olds and 2.6% of 11 year olds measured had height less than the third centile (compared with Tanner's height standards). CONCLUSIONS: School nurses measured height reliably. New audit procedures led to rapid changes in working practice and improvements in the percentage of children measured. The low numbers of short children previously identified with unrecognised abnormality may indicate an upward trend in height in this inner city population.

Body Height↗

PubMed2006

A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study.

INTRODUCTION: The Acute Physiology and Chronic Health Evaluation (APACHE) II score is widely used in the intensive care unit (ICU) as a scoring system for research and clinical audit purposes. Physiological data for calculation of the APACHE II score are derived from the worst values in the first 24 hours after admission to the ICU. The collection of physiological data on admission only is probably logistically easier, and this approach is used by some ICUs. This study compares the performance of APACHE II scores calculated using admission data with those obtained from the worst values in the first 24 hours. MATERIALS AND METHODS: This was a retrospective cohort study using prospectively collected data from a tertiary ICU. There were no missing physiological data and follow-up for mortality was available for all patients in the database. The admission and the worst 24-hour physiological variables were used to generate the admission APACHE II score and the worst 24-hour APACHE II score, and the corresponding predicted mortality, respectively. RESULTS: There were 11,107 noncardiac surgery ICU admissions during 11 years from 1 January 1993 to 31 December 2003. The mean admission and the worst 24-hour APACHE II score were 12.7 and 15.4, and the derived predicted mortality estimates were 15.5% and 19.3%, respectively. The actual hospital mortality was 16.3%. The overall discrimination ability, as measured by the area under the receiver operating characteristic curve, of the admission APACHE II model (83.8%, 95% confidence interval = 82.9-84.7) and the worst 24-hour APACHE II model (84.6%, 95% confidence interval = 83.7-85.5) was not significantly different (P = 1.00). CONCLUSION: Substitution of the worst 24-hour physiological variables with the admission physiological variables to calculate the admission APACHE II score maintains the overall discrimination ability of the traditional APACHE II model. The admission APACHE II model represents a potential alternative model to the worst 24-hour APACHE II model in critically ill nontrauma patients.

APACHE↗

PubMed2003

Characteristics of effective clinical guidelines for general practice.

BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for general practice, and to explore whether these differ between therapeutic and diagnostic recommendations. DESIGN OF STUDY: Analysis of performance data from an audit study of 200 general practitioners (GPs) in The Netherlands conducted in 1997. SETTING: Panel of 12 GPs in The Netherlands who were familiar with guideline methodology. METHOD: A set of 12 attributes, including six potential facilitators and six potential barriers to guideline use, was formulated. The panel assessed the presence of these attributes in 96 guideline recommendations formulated by the Dutch College of General Practitioners. The attributes of recommendations with high compliance rates (70% to 100%) were compared with those with low compliance rates (0% to 60%). RESULTS: Recommendations with high compliance rates were to a lesser extent those requiring new skills (7% compared with 22% in recommendations with low compliance rates), were less often part of a complex decision tree (12% versus 25%), were more compatible with existing norms and values in practice (87% versus 76%), and more often supported with evidence (47% versus 31%). For diagnostic recommendations, the ease of applying them and the potential (negative) reactions of patients were more relevant than for therapeutic recommendations. CONCLUSION: To bridge the gap between research and practice, the evidence as well as the applicability should be considered when formulating recommendations. If the recommendations are not compatible with existing norms and values, not easy to follow or require new knowledge and skills, appropriate implementation strategies should be designed to ensure change in daily practice.

Family Practice↗

PubMed2003

Determination of delay in turn around time (TAT) of stat tests and its causes: an AKUH experience.

OBJECTIVE: To evaluate the delay and reasons of delay of turn around time (TAT) of stat tests in the section of clinical chemistry of the clinical laboratory. SETTING: Clinical Laboratory, Aga Khan University Hospital, Karachi. PATIENTS AND METHODS: In our study turn around time (TAT) of stat tests were analyzed. Turn around time was specified as the time from receipt of the sample till the final verification of results (sample receipt time to result verification time). Delays were categorized into 15 minutes, 16-30 minutes, 31 to 60 minutes and > 60 minutes. It was also noted as to which time of the day was delay in reporting stat results occurred. Reasons for the delay were also looked into. RESULTS: Total 20079 stat samples were received from August 2001 till October 2001. Four hundred eight (2.03%) samples were reported after the acceptable turnaround time. Cumulative analysis of the excess TAT of stat tests showed that 0-15 minutes delay was noted in 68 (16.7%) samples, 16-30 minutes delay in 80(19.6%) samples, 31-60 minutes delay in 76 (18.6%) samples as and more than 60 minutes delay in 185 (45.3%) of samples. Most of the delay in reporting of stat test in three months time was surprisingly noted in the morning shift. Overall delay in reporting in morning shift was found to be of 242 (59.3%) samples. In the evening and night shift 83 (20.3%) and 82 (20.1%) samples respectively were found to be delayed. Reasons for delay in TAT were as follows: n = 163 (40%) due to machine breakdown, n = 147(36%) due to delay in the maintenance of analyzers, n = 73 (18%) due to overlook of the staff during shift change (e.g. night shift to morning shift) and n = 25 (6%) due to computer shutdown. CONCLUSION: We conclude that most of the delay in TAT of stat tests in our laboratory occurred for more than 60 minutes and was frequently seen in the morning shift. It was also noticed that machine breakdown was the most common reason for this delay. Regular audit of such data helps in the evaluation of the efficiency of the laboratory and hence corrective measures taken accordingly would be helpful in providing better service to the physicians and patients.

Clinical Laboratory Techniques↗

PubMed1986

NTP Toxicology and Carcinogenesis Studies of Decabromodiphenyl Oxide (CAS No. 1163-19-5) In F344/N Rats and B6C3F1 Mice (Feed Studies).

Toxicology and carcinogenesis studies of decabromodiphenyl oxide, a flame retardant for plastics and other materials, were conducted by exposing groups of 50 male and 50 female F344/N rats and B6C3F1 mice at 0, 25,000, and 50,000 ppm in the diet for 103 weeks. These concentrations were selected because no toxicity was observed at any dose in the 14-day or 13-week studies and 50,000 ppm chemical in the diet is considered to be the highest dose to which rats and mice can be exposed for extended periods of time without reducing the nutritional value of the diet. No compound-related gross or microscopic pathologic effects were observed in the 14-day or 13-week studies. Body weights of dosed male and female rats and mice in the 2-year studies were comparable to those of the controls. Decreased survival of low dose male rats was not believed to be compound related. No other effects on survival were observed in the 2-year studies. Loss of control male mice (presumably due to fighting) was significant during the first part of the study. In the 2-year studies, nonneoplastic lesions were observed at increased incidences in rats and mice of each sex. Thrombosis and degeneration of the liver, fibrosis of the spleen, and lymphoid hyperplasia were observed in high dose male rats. Degeneration of the eye was observed in low dose female rats. Nonneoplastic lesions observed in dosed mice were granulomas in the liver of low dose males and hypertrophy in the liver of low dose and high dose males. Follicular cell hyperplasia was observed in thyroid glands of dosed male mice (control, 2/50; low dose, 10/50; high dose, 19/50). The incidences of neoplastic nodules in the liver of low and high dose male rats (1/50; 7/50; 15/49) and high dose female rats (1/50; 3/49; 9/50) were significantly greater than those in the controls. Mononuclear cell leukemia occurred in dosed male rats with a positive trend (30/50; 33/50; 35/50); this marginal increase was not considered biologically significant. Acinar cell adenomas were observed in the pancreas of four high dose male rats, and a sarcoma was observed in the spleen of one low dose and one high dose male rat. Hepatocellular adenomas or carcinomas (combined) occurred at marginally increased incidences in dosed male mice (8/50; 22/50; 18/50). The incidences of thyroid gland follicular cell adenomas or carcinomas (combined) were increased in dose male mice (0/50; 4/50; 3/50). A study of decabromodiphenyl oxide absorption from the gastrointestinal tract indicated that absorption was minimal, possibly less than 1%, at the doses administered in the 2-year studies. Additional chemical analysis indicated than the decabromodiphenyl oxide used in these studies contained several less brominated diphenyl oxides. Therefore, since absorption and toxicity of minor impurities are unknown, effects observed in these studies must be attributed to the approximately 95% pure preparation used rather than to pure decabromodiphenyl oxide. Decabromodiphenyl oxide was not mutagenic in strains TA1535, TA1537, TA98, or TA100 of Salmonella typhimurium in the presence or absence of Aroclor 1254-induced Sprague-Dawley male rat or Syrian hamster liver S9 when tested according to the preincubational protocol. Decabromodiphenyl oxide was not mutagenic in the mouse lymphoma L5178Y/TK+/- assay in the presence or absence of Aroclor 1254-induced F344/N male rat liver S9. Decabromodiphenyl oxide did not induce sister-chromatid exchanges or chromosomal aberrations in Chinese hamster ovary cells in vitro in the presence or absence of S9 prepared from livers of Aroclor 1254-induced male Sprague-Dawley rats. An audit of experimental data was conducted for these 2-year studies on decabromodiphenyl oxide. No data discrepancies were found that influenced the final interpretations. Under the conditions of these 2-year feed studies of decabromodiphenyl oxide, there was some evidence of carcinogenicity for male and female F344/N rats as shown by increased incidences of neoplastic nodules of the liver in low dose (25,000 ppm) males and high dose (50, and high dose (50,000 ppm) groups of each sex. There was equivocal evidence of carcinogenicity for male B6C3F1 mice as shown by increased incidences of hepatocellular adenomas or carcinomas (combined) in the low dose group and of thyroid gland follicular cell adenomas or carcinomas (combined) in both dosed groups. There was no evidence of carcinogenicity for female B6C3F1 mice receiving 25,000 or 50,000 ppm in the diet. Several nonneoplastic lesions were observed at increased incidences, the most notable being thyroid gland follicular cell hyperplasia in male mice. Synonyms: decabromodiphenyl ether; bis(pentabromophenyl)ether; DBDPO

Journal Article↗

PubMed2003

Off-pump coronary artery bypass: the Sudbury experience.

OBJECTIVE: To examine factors relating to outcomes with off-pump coronary artery bypass (OPCAB) and to assess methods to improve the effectiveness of this approach SETTING: A small northern Ontario community hospital where surgical assistance, nursing familiarity with OPCAB and even anesthesiologist comfort varied DESIGN: Prospective collection of data with incremental audit of results and retrospective analysis of events METHODS: One hundred twenty-four consecutive patients, operated on by the same surgeon between April 1996 and June 2002, were selected on the basis of coronary anatomy. Progressively more complex multivessel revascularization, including that to the posterior wall, was undertaken over the course of the study period. Every attempt was made not to compromise use of arterial conduits, quality of anastomoses or completeness of revascularization. This represents the 'learning curve' of this study. MAIN RESULTS: Approximately 6% of patients developed a hemodynamic crisis requiring acute on-pump conversion. This tended to occur in patients undergoing complex multivessel OPCAB surgery and was associated with subsequent increased blood transfusion rate, operative time and mortality (2.8%), and poorer angiographic graft patency. This has led to a more cautious strategy including making the decision to proceed with OPCAB only after intraoperative assessment. CONCLUSION: 'Simple' OPCAB on easily accessible coronary arteries resulted in excellent early outcomes. Complex multivessel OPCAB for triple vessel disease involving difficult to access arteries was more demanding with higher perioperative complications and less effectiveness. Early enthusiasm for complex multivessel surgery has been gradually replaced with a more conservative use of OPCAB with improved intraoperative procedures, both of which have led to more favourable outcomes.

Adult↗

PubMed1992

Computerized health information in The Netherlands: a registration network of family practices.

A registration network of family practices (Registratienet Huisartspraktijken) has recently been established in the Netherlands. Forty two general practitioners in 15 practices, with a patient population of 80,000 people, are using a general practice health information system to establish a central computerized anonymous database containing certain patient characteristics and all relevant health problems. By September 1990 patient characteristics and problem lists for 32,972 patients had been entered and a total of 94,476 health problems had been identified. The database has been set up primarily as a sampling frame, allowing researchers to identify patients with particular health problems. The database can also provide descriptive data on prevalence and incidence rates, fulfil a monitoring function and provide data for practice audit, medical education and health management.

Adolescent↗