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At least 73 records · Page 4Linked to original sources
PubMed1989

Development of a coding system for recording clinical findings in farm animal practice.

A coding system was developed for recording veterinary information in the University of Liverpool farm animal practice. Existing coding systems were found to be unsuitable for use on a microcomputer in a veterinary practice. A number of new coding formats were developed and tried. The need to record varying detail, to analyse data and to enter data quickly resulted in biaxial hierarchical codes. These are used in an automated coding system to record all veterinary and reproduction information in the practice.

Animals↗
PubMed1993

Assessment of global and regional myocardial function using the Minnesota Q/QS codes. A comparison with clinical ECG interpretation.

The authors investigated 244 consecutive patients with suspected coronary artery disease by coronary angiography and quantitative left ventriculography to compare the Minnesota Q/QS code (MC) with clinical electrocardiographic (ECG) interpretation. Patients who were suspected to have wall motion abnormalities for reasons other than coronary artery disease for possible regional wall motion abnormalities were excluded. Out of 244 patients, 159 (65%) had wall motion abnormalities. The sensitivity for detecting wall motion abnormalities was 21% for MC 1.1 and 51% for MC 1.1-3, whereas clinical ECG interpretation showed a sensitivity of 73%. Specificity for MC 1.1 was 93% and for MC 1.1-3 it was 84%. Specificity of clinical ECG interpretation (84%) was comparable. Compared to the MC, clinical ECG interpretation showed a stronger association with left ventricular ejection fraction, number of segments with abnormal wall motion, and severity of wall motion abnormality. Anterior myocardial infarction presented more often with clinical ECG changes (71%) and with a Q/QS code (50%) than inferior myocardial infarction (61% and 41%, respectively). In summary, in contrast to clinical ECG criteria, the MC has high specificity at the expense of a low sensitivity.

Cineradiography↗
PubMed1996

Using bar-code technology to capture clinical intervention data in a hospital with a stand-alone pharmacy computer system.

The use of bar-code technology to capture data on pharmacists' clinical interventions is described. At a hospital in Northern Ireland, patient-specific information could not be accessed through the pharmacy computer system. A system comprising six hand-held bar-code readers and software for downloading data was purchased. The pharmacy staff selected a range of fields for recording a wide array of data on clinical interventions, including the outcomes. Patient details that could not easily be bar-coded had to be recorded manually. The process was evaluated over three four-week cycles, with the data fields being revised after each cycle and the interventions being judged for their clinical appropriateness and their conformance to inhouse standards. After the third cycle, the need for manual recording of information was eliminated. A total of 857 interventions were made during the three cycles. Performance met or exceeded the standard for 7 (50%) of 14 indicators for the first cycle, 8 (53%) of 15 for the second cycle, and 13 (81%) of 16 for the final cycle. For all three cycles, the majority of the interventions were important and resulted in an improvement in the standard of care. A bar-code-driven data collection system successfully replaced a manual system for documenting pharmacists' clinical interventions.

Clinical Pharmacy Information Systems↗
PubMed1991

Code of practice for clinical proton dosimetry.

The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This Code of Practice is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alternatively, an ionization chamber, with a 60Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +/- 5% (1 S.D.) in all cases. Adoption and implementation of this Code of Practice will facilitate the exchange of clinical information.

Cobalt Radioisotopes↗
PubMedDate not supplied

Clinical terms project: a coding system for clinicians.

Advances in information management and technology are necessary for improved communication, research and resource management in the health service. The medical profession must be closely involved in the development of a computer-based communications network if it is to be clinically useful and acceptable. The Read codes have been developed by clinicians and form the basis of an entire clinical information system.

England↗
PubMedDate not supplied

[Comparison between peak expiratory flow rate and daily report of the symptoms in asthmatic children (author's transl)].

In a group of 140 asthmatic children (6-15 years old) followed up for six months, the authors compared : (1) the daily transcription of asthmatic symptoms, of their intensity and of the use of antibiotics or corticosteroids ; (2) the peak expiratory flow rate measured daily at nine a.m. ; (3) the clinical history, coded every fifth day. A clinical score was computed by multiple linear correlation between (1) and (3), with a correlation coefficient of 0.84 (p less than 0.001), showing that the propounded quantification of symptoms and treatments was very good for estimating the clinical history. The coefficient of simple linear correlation between peak expiratory flow rate and score (r = --0.41) and between peak expiratory flow rate and clinical history (r = --0.65) was statistically significant ; however a further computation by stepwise multiple linear correlation showed that the peak expiratory flow rate was essentially correlated to the intensity of the symptoms, and to a lesser degree to the presence of breathlessness and prescription of corticosteroids. The correlation coefficient was -- 0.55 (p less than 0.01). Thus the peak expiratory flow rate does not very well account for the clinical state of asthmatics ; useful for the fast but superficial monitoring of patients, it cannot replace the daily transcription of symptoms and treatments : both methods are complementary.

Adolescent↗
PubMed1996

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson's disease.

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD). DESIGN: A cohort study with 18-month follow-up utilizing resident assessments from the National HealthCorp 1991-1992 dataset. SETTING: Seventy-one National HealthCorp nursing homes. PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using the International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0. MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status. RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 +/- 7 vs 81 +/- 9 years; P < .001), male sex (32% vs 23%; P < .001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08-1.46), impared body control (OR = 1.38; 95% CI 1.03-1.68), symptoms of depression (OR = 1.29; 95% CI 1.02-1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08-1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P < .001) but did not have a higher mortality rate than residents without PD. CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.

Activities of Daily Living↗
PubMed1996

Monte Carlo-based treatment planning for boron neutron capture therapy using custom designed models automatically generated from CT data.

PURPOSE: A Monte Carlo-based treatment planning code for boron neutron capture therapy (BNCT), called NCTPLAN, has been developed in support of the New England Medical Center-Massachusetts Institute of Technology program in BNCT. This code has been used to plan BNCT irradiations in an ongoing peripheral melanoma BNCT protocol. The concept and design of the code is described and illustrative applications are presented. METHODS AND MATERIALS: NCTPLAN uses thin-slice Computed Tomography (CT) image data to automatically create a heterogeneous multimaterial model of the relevant body part, which is then used as input to a Monte Carlo simulation code, MCNP, to derive distributions within the model. Results are displayed as isocontours superimposed on precisely corresponding CT images of the body part. Currently the computational slowness of the dose calculations precludes efficient treatment planning per se, but does provide the radiation oncologist with a preview of the doses that will be delivered to tumors and to various normal tissues, and permits neutron irradiation times in Megawatt-minutes (MW-min) to be calculated for specific dose prescriptions. The validation of the NCTPLAN results by experimental mixed-field dosimetry is presented. A typical application involving a cranial parallel-opposed epithermal neutron beam irradiation of a human subject with a glioblastoma multiforme is illustrated showing relative biological effectiveness-isodose (RBE) distributions in normal CNS structures and in brain tumors. Parametric curves for the MITR-II M67 epithermal neutron beam, showing the gain factors (gain factor = minimum tumor dose/maximum normal brain dose) for various combinations of boron concentrations in tumor and in normal brain, are presented. RESULTS: The NCTPLAN code provides good computational agreement with experimental measurements for all dose components along the neutron beam central axis in a head phantom. For the M67 epithermal beam the gain factor for 1, boronophenylalanine for a small midline brain tumor under typical distribution assumptions is 1.4-1.8 x . Implementation of the code under clinical conditions is demonstrated. CONCLUSION: The NCTPLAN code has been shown to be well suited to treatment-planning applications in BNCT. Comparison of computationally derived dose distributions in a phantom compared with experimental measurements demonstrates good agreement. Automatic superposition of isodose contours with corresponding CT image data provides the ability to evaluate BNCT doses to tumor and to normal structures. Calculation of gain factors suggests that for the M67 epithermal neutron beam, more advantage is gained from increasing boron concentrations in tumor than from increasing the boron tumor-to-normal brain ratio.

Boron Neutron Capture Therapy↗
PubMed1995

Is the use of psychotropic drugs associated with increased risk of ischemic heart disease?

Earlier reports of associations between panic disorder, depression, and ischemic heart disease have not evaluated the role of the drugs used to treat these conditions. As part of a larger study on reducing cardiovascular disease in an entire community, we estimated the association between psychotropic drugs and ischemic heart disease in a large community-based population using a cohort study design. We defined exposure as current use of psychotropic medications at the time of the health interview. We determined ischemic heart disease by International Classification of Diseases, 9th revision, Clinical Modification, codes and by an epidemiologic algorithm using clinical diagnostic criteria. An elevated risk for clinically significant ischemic cardiac events was moderately associated with benzodiazepine use [relative risk (RR) = 2.0; 90% confidence interval (CI) = 1.1-3.9] and strongly associated with antidepressant use (RR = 5.7; 90% CI = 2.6-12.8), although the latter estimate was based on only six antidepressant users who had an ischemic event.

Adult↗
PubMed1988

Coding of acute myocardial infarction. Clinical and policy implications.

STUDY OBJECTIVE: To evaluate the appropriateness of diagnostic coding of acute myocardial infarction across teaching and nonteaching hospitals. DESIGN: Retrospective review of a random sample of medical records to find evidence of the occurrence and active treatment of acute myocardial infarction during the admission. SETTING: Five tertiary teaching, five other teaching, and five nonteaching hospitals in metropolitan Boston. CASES: Random sample of hospital admissions assigned a discharge diagnosis of acute myocardial infarction between October 1984 and September 1985. MEASUREMENT AND MAIN RESULTS: Of the 1003 cases reviewed, 260 did not meet the clinical criteria for acute myocardial infarction. At tertiary hospitals, 175 (41.7%) failed to qualify, compared with 25 (9.1%) at nonteaching facilities. In a large fraction of the disqualified cases, the patients had been admitted to exclude the diagnosis of acute myocardial infarction; although explicitly "ruled out," an acute myocardial infarction code was assigned. Sixty-six cases from teaching hospitals did not qualify because the patient had been admitted only for coronary angiography after an uneventful postmyocardial infarction course. Almost one-third of these patients had had their infarcts from 5 to 8 weeks before the angiography admission. CONCLUSIONS: Cases with an inappropriate discharge diagnosis of acute myocardial infarction may be concentrated in teaching hospitals. This finding could have implications for Medicare's diagnosis-related group payment system and governmental and other research efforts that use these data for such purposes as drawing inferences about the quality of hospital care.

Boston↗
PubMed1976

Organizing patient data for use in clinical pharmacy practice and education.

A simple, low-cost manual data retrieval system, which provides selective access to all patient cases monitored by pharmacists, is described. The system uses notched cards which are coded by clinical descriptors. The codes are based on a modification of the International Calssification of Diseases, Adapted, disease-diagnosis coding system. This multiple entry system is flexible and can be easily converted to a computer-based system.

Education, Pharmacy↗