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Functional annotation of fully sequenced genomes is still a major issue. High-throughput data sets could be used to provide more and better functional annotations. However differences in data quality need to be taken into account. For this purpose these high-throughput data sets need to be integrated so that the data quality can be assessed, hypotheses can be prioritized and existing annotations can be improved and extended.
The aim of the present study was to provide data on the reliability and validity of a Danish translation of the Dermatology Life Quality Index (DLQI), a short measure of the impact of dermatological diseases on quality of life. The DLQI was administered to 200 outpatients and 100 hospitalized patients suffering from a range of dermatological diseases and to 100 sex- and age-matched healthy controls. Mean scores, internal consistency and test-retest reliability were comparable to the results reported for the original English version. Hospitalized patients reported greater impairment of disease-related quality of life than outpatients, and patients with atopic dermatitis and psoriasis exhibited greater scores than patients suffering from other dermatological diseases. Discriminant, construct and predictive validities of the Danish translation of the DLQI were satisfactory, as indicated by significant associations between DLQI scores and physician-rated disease severity, disease duration and the time patients were willing to spend each day on a hypothetical effective treatment. The results also suggest that the emphasis Danish patients place on various aspects of disability covered by the questionnaire is similar to that of English patients. In conclusion, the Danish translation of the DLQI showed satisfactory reliability and the preliminary results indicate that this version is a valid measure, which can be used in both research and clinical settings.
A comparative assessment of the risks of three effluent disposal alternatives currently available to wastewater utilities in Southeast Florida is presented in this paper. The alternatives are: deep well injection and ocean outfalls following secondary treatment, and surface water (canal) discharges following secondary wastewater treatment, filtration and nutrient removal. Water quality data, relative to disposal of wastewater treatment plant effluent were gathered, along with water quality data on the receiving waters, from utilities. Comparisons and conclusions regarding potential health concerns associated with the three disposal alternatives are presented. The results indicated that health risks associated with deep wells were generally lower than those of the other two alternatives. The proximity of injection wells to aquifer storage and recovery wells was a determining factor relative to injection well risk. Urban ecological risks were also indicated to be lower, though impacts of urban water use/reuse to the Everglades were not studied. Additional data collection and analysis were recommended to understand the effects of wastewater management on the cycling of water, nutrients and other constituents on southeast Florida. In particular, it was recommended that monitoring of effluents for nitrosamines and pharmaceutically active substances be implemented on a broad scale.
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Working memory dysfunction is a prominent impairment in patients with schizophrenia. Our aim was to determine cerebral dysfunctions by means of functional magnetic resonance imaging (fMRI) in a large sample of first-episode schizophrenia patients during a working memory task. 75 first-episode schizophrenia patients and 81 control subjects, recruited within a multi-center study, performed 2- and 0-back tasks while brain activation was measured with fMRI. In order to guarantee comparability between data quality from different scanners, we developed and adopted a standardized, fully automated quality assurance of scanner hard- and software as well as a measure for in vivo data quality. After these quality-control measures had been implemented, 48 patients and 57 controls were included in the final analysis. During attention-related processes, even when the performance between patients and controls was comparable, there was a recognizable emergence of cerebral dysfunctions with hypoactivations in the ventrolateral prefrontal cortex (VLPFC), in the superior temporal cortex and in the thalamus. During working memory performance, parietal hypoactivations, especially in the precuneus, were prominent and were accompanied by poorer performance in patients. A hyperfrontality emerged in the ventrolateral prefrontal cortex. Hence, results point to a dysfunctional ventrolateral prefrontal-parietal network during working memory in patients, suggesting impairments in basic functions such as retrieval, storage and maintenance. The brain activation pattern of this large and significant sample of first-episode schizophrenia patients indicates an imbalanced system failing to adjust the amount of brain activity required in the cerebral network involved in attention and working memory.
Microcomputers are now widely used in clinical laboratories because of their low price and the availability of a wide variety of software that can be adapted to the users' requirements. The continuously increasing numbers of patients, tests and the use of automation are additional factors which emphasize the need for computers. A microcomputer software that meets the exact requirements of the Quality Control Unit was developed to evaluate laboratories participating in the Kuwait National Bacteriological Quality Assessment Scheme.
BACKGROUND: Cleveland Health Quality Choice is a regional initiative to assess hospital performance which was implemented in 1989. The project developed and validated CHOICE, a severity adjustment system that includes diagnosis-specific models for medical, surgical, and obstetrical patients which are based on clinical data abstracted from patients' medical records. METHODOLOGY: Since 1992 Cleveland Health Quality Choice has disseminated semi-annual reports that profile hospital mortality rates, lengths of stay, and cesarean section rates using the CHOICE severity adjustment models. Hospitals receive tabular and graphical representations of hospital outcomes and electronic patient-level data files that can be used to further examine outcomes in clinical subgroups. RESULTS: Four case studies illustrate how outcomes data derived from the CHOICE models led to the development of successful hospital programs to decrease lengths of stay, cesarean section rates, and hospital mortality rates. Although each case study reflected a unique approach to process improvement, several common characteristics were observed: (1) establishment of interdisciplinary process improvement teams with senior physician and nursing leadership; (2) detailed review of the process of care to identify modifiable clinical practices likely to affect outcomes; (3) development of practice guidelines based on group consensus or published recommendations that were designed to affect modifiable practices; and (4) aggressive sharing of serial data with individual practitioners. CONCLUSIONS: Although outcomes data can provide powerful insight on where to target quality improvement efforts, hospitals must identify influential and modifiable clinical practices. Such efforts are most likely to be successful if driven by interdisciplinary work groups, supported by senior clinicians and administrators, and based on locally accepted practice standards.
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This commentary discusses 4 issues relevant to interpretation of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) article: (a) Self-reported compliance in medical settings has generally been substantially higher than verified compliance, suggesting that this is not a rare phenomenon; (b) none of the studies reported in Green et al. explicitly verified paper diary compliance; (c) the impact of participant motivation on diary compliance is unknown, and it may be difficult for researchers to accurately assess it in their own studies; and (d) without objective verification of diary compliance, analysis of the effects of noncompliance on data quality is difficult to interpret. The authors conclude that compliance in paper diaries and the effects of noncompliance on data quality are still unsettled issues.
RATIONALE AND OBJECTIVES: The authors performed this study to determine, in the context of a teaching presentation with slides, the information content needed in a digitized radiologic image for it to be equivalent in quality to an analog image. MATERIALS AND METHODS: Eleven sets of radiologic images were obtained from a teaching file collection and digitized. The images were scanned at high resolution and saved as image files. The information content of each image was then halved repeatedly with repeat sampling of the image. This procedure was repeated nine times to yield a total of 10 images with an information content that ranged from very low (32 kB) to high (12 MB). Each of these image files was made into a 35-mm slide by using a digital slide maker. The original radiographs were subsequently made into slides by using conventional photographic methods. Care was taken to make the images identical in every respect except digitization and information content. The slides were shown to radiologists, who filled out questionnaires to rate image quality. RESULTS: Digitized slides that contain an average of 416 kB of data (the equivalent of a 750 x 570-pixel matrix with 8-bit gray levels) were equivalent to analog images for 90% of viewers. At 830 kB (1,060 x 800-pixel matrix with 8-bit gray levels), 100% of viewers found no difference between digitized and analog images. CONCLUSION: Digital images become indistinguishable from analog images if a sufficient amount of information is retained in the digital image. There is a defined relationship between the perception of quality and the information content of a digital image.
The Tumor Registry wheel has a sound, tested, basic design and could serve the dual purpose of a Radiation Oncology QADB. Many of the issues raised by Williamson regarding a QADB have already been addressed and tested by the Tumor Registry and commercially available Tumor Registry software. Registry personnel are trained in this type of data collection, coding and reporting. You may already have a Tumor Registry that has the capacity to provide this service to your department with the addition of only minimal efforts. If your Tumor Registry only collects minimal data now, it is probably because it has only minimal support and use. If you choose to utilize the Tumor Registry for your Radiation Oncology QADB, your department can provide additional support in many ways in return for the services provided to you. Maximum support can be given by assuming full responsibility and locating the registry in the Radiation Oncology cost center. As mentioned earlier, many Radiation Oncologists have recognized the variety of benefits derived from this situation. Other forms of assistance might include financial support for the upgrading of computer hardware and software required to facilitate these new needs, or by providing additional secretarial personnel, possibly on a part-time basis. Support voiced to the administration from the Radiation Oncologist for the need and use of the Tumor Registry can be helpful in getting approval for upgrading tumor registry equipment or obtaining adequate personnel. Developing a symbiotic relationship between these two departments can strengthen the entire Cancer Program as well as each of the individual departments.(ABSTRACT TRUNCATED AT 250 WORDS)
INTRODUCTION: Risk adjustment is essential before comparing patient outcomes across hospitals. With this aim several risk adjustment systems have been developed, including the well-known diagnosis related groups. MATERIAL AND METHODS: Narrative review on risk assessment framework from administrative databases, including data quality and system pitfalls. RESULTS: The risk adjustment systems developed for cost-control aims to group different patient typologies in relation to the predicted use of resources with the aim to develop incentives to cost-reduction; the systems developed for measuring effectiveness have the objective to assess the health care quality. Both systems are useful for clinical, management and health public uses, but they have several pitfalls and their results should be interpreted cautiously. CONCLUSIONS: Managers and physicians should consider the risk adjustment systems as a valuable resource for decision-making and reducing uncertainty, but not as the scientific referee of hospital quality or hospital efficiency.
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BACKGROUND: Despite evidence supporting an association between ambient air pollutants and cardiovascular disease (CVD), the roles of the physicochemical components of particulate matter (PM) and copollutants are not fully understood. This time-series study examined the relation between ambient air pollution and cardiovascular conditions using ambient air quality data and emergency department visit data in Atlanta, Georgia, from January 1, 1993, to August 31, 2000. METHODS: Outcome data on 4,407,535 emergency department visits were compiled from 31 hospitals in Atlanta. The air quality data included measurements of criteria pollutants for the entire study period, as well as detailed measurements of mass concentrations for the fine and coarse fractions of PM and several physical and chemical characteristics of PM for the final 25 months of the study. Emergency department visits for CVD and for cardiovascular subgroups were assessed in relation to daily measures of air pollutants using Poisson generalized linear models controlling for long-term temporal trends and meteorologic conditions with cubic splines. RESULTS: Using an a priori 3-day moving average in single-pollutant models, CVD visits were associated with NO2, CO, PM2.5, organic carbon, elemental carbon, and oxygenated hydrocarbons. Secondary analyses suggested that these associations tended to be strongest with same-day pollution levels. CONCLUSIONS: These findings provide evidence for an association between CVD visits and several correlated pollutants, including gases, PM2.5, and PM2.5 components.