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At least 757 records · Page 42Linked to original sources
PubMed1990

Computerized extraction of coded findings from free-text radiologic reports. Work in progress.

A computerized data acquisition tool, the special purpose radiology understanding system (SPRUS), has been implemented as a module in the Health Evaluation through Logical Processing Hospital Information System. This tool uses semantic information from a diagnostic expert system to parse free-text radiology reports and to extract and encode both the findings and the radiologists' interpretations. These coded findings and interpretations are then stored in a clinical data base. The system recognizes both radiologic findings and diagnostic interpretations. Initial tests showed a true-positive rate of 87% for radiographic findings and a bad data rate of 5%. Diagnostic interpretations are recognized at a rate of 95% with a bad data rate of 6%. Testing suggests that these rates can be improved through enhancements to the system's thesaurus and the computerized medical knowledge that drives it. This system holds promise as a tool to obtain coded radiologic data for research, medical audit, and patient care.

Artificial Intelligence↗
PubMed1994

Sex differences in the management and long-term outcome of acute myocardial infarction. A statewide study. MIDAS Study Group. Myocardial Infarction Data Acquisition System.

BACKGROUND: We wished to evaluate whether differences in the rate of invasive cardiac procedures between men and women with acute myocardial infarction are associated with different short- and long-term mortality. METHODS AND RESULTS: The database (Myocardial Infarction Data Acquisition System, MIDAS) included all discharges for the years 1986 and 1987 with the diagnosis of acute myocardial infarction in New Jersey, based on the New Jersey hospital discharge data system (MIDS/UB-82). Accuracy of the data was evaluated by auditing 726 randomly selected charts. The variables examined included age, sex, race, comorbidity (anemia, chronic liver disease, cancer, chronic obstructive pulmonary disease, diabetes, hypertension, prior myocardial infarction), complications (left ventricular dysfunction, arrhythmias, conduction defects), insurance status, performance of cardiac catheterization, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery, and survival up to 3 years. Women were older, had longer hospital stay, and were more likely than men to have anemia, diabetes, hypertension, left ventricular dysfunction, and Medicare or Medicaid insurance coverage. They were less likely than men to be admitted to a hospital equipped to perform invasive procedures or to have chronic obstructive pulmonary disease, chronic liver disease, prior myocardial infarction, or arrhythmias. After adjustment for these differences, women were less likely than men to have cardiac catheterization. Cardiac catheterization was associated with lower mortality. Women up to age 70 had higher 3-year death rates than men after adjustment for age, race, comorbidity, complications, and insurance type. This difference between men and women was somewhat diminished after the performance of cardiac catheterization and revascularization was taken into account. Unadjusted mortality was high in this study group. CONCLUSIONS: Women with acute myocardial infarction are less likely to have invasive cardiac procedures and have higher 3-year adjusted death rate up to age 70 than men.

Aged↗
PubMed2004

Prehospital thrombolysis--calculated health benefit for catchment population of one hospital.

The health benefit of thrombolysis in acute myocardial infarction is greatest when patients are treated soon after onset of symptoms. One approach to reducing treatment delay is to give thrombolysis before the patient reaches hospital. When an ambulance trust proposed a prehospital thrombolysis service, local commissioners requested an estimate of its possible health impact. Clinical audit and ambulance trust data were obtained for 165 patients who received thrombolysis for acute myocardial infarction in the coronary care unit of a local hospital in one year. This information was then used to estimate the health impact of prehospital thrombolysis in the local population in a mathematical model derived from the results of trials comparing prehospital and hospital thrombolysis. The best predicted local health benefit from the proposed prehospital thrombolysis service is that, if 45 minutes can be cut off the call-to-needle time, 61 cases of acute myocardial infarction need to be treated to save one additional life at 35 days. By use of published research data, the health benefits of prehospital thrombolysis can be estimated for a local population. Variables in the treatment population and ambulance service will influence the size of the health benefit that can be achieved.

Adult↗
PubMed2003

An audit of Keller arthroplasty and metatarsophalangeal joint arthrodesis from national data.

Chronic interphalangeal ulcerations of the great toe are a frequent complication in neuropathic diabetic feet. While total contact casting is usually effective as a first-line treatment, some ulcers continue and present substantial management challenges. The objective of this study was to examine the National Hospital Discharge Survey in order to identify links between preexisting medical conditions and lower extremity pathology in patients undergoing a Keller arthroplasty. Those who received a Keller arthroplasty were more likely to have diabetes mellitus (odds ratio [OR] = 4.00, 95% confidence interval [CI]: 3.73-4.30, P = .0001), diabetic neuropathy (OR = 3.80, 95% CI: 3.48-4.15, P = .0001), coronary artery disease (OR = 1.78, 95% CI: 1.57-2.03), or peripheral vascular disease (PVD) (OR = 2.06, 95% CI: 1.49-2.84, P = .0001). Keller arthroplasty patients were less likely to have a foot abscess (OR = 0.44, 95% CI: 0.39-0.50, P = .0001) or hammer toe deformity (OR = 0.60, 95% CI: 0.57-0.63, P = .0001), but more likely to have a foot wound or ulcer (OR = 2.62, 95% CI = 2.44-2.82, P = .0001), bunions (OR = 4.52, 95% CI: 4.26-4.80, P = .0001), and osteomyelitis (OR = 2.65, 95% CI: 2.41-2.92, P = .0001). Hallux limitus or rigidus in a diabetic patient with neuropathy, peripheral vascular disease, and poor healing subjects this patient to a higher risk of ulceration, infection, and amputation. This study shows that this procedure is being performed in the diabetic population with attendant complications.

Journal Article↗
PubMed1996

The treatment of depression: prescribing patterns of antidepressants in primary care in the UK.

BACKGROUND: Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines. METHOD: Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database. RESULTS: Data were obtained on populations in excess of 1.5 million people, and over 80,000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants-lofepramine and the SSRIs-are prescribed comparatively well. CONCLUSIONS: Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.

Antidepressive Agents↗
PubMed2002

Beds, budgets and burdens: learning disability expenditure v. workload across English health authorities. Comparative review.

BACKGROUND: Following the closure of asylums and widespread changes in the population distribution of people with learning disabilities, there has been little investigation of changing expenditure requirements of health authorities in England. AIMS: To compare expenditure on learning disability health services across England with the burden of services regionally, as estimated by numbers of people with learning disabilities. METHOD: A national database was set up using data from the National Audit Commission and the Department of Health. The spend/burden ratio was calculated and correlation tests for likely causes of inequality were applied. RESULTS: There is widespread discrepancy from the median spend/burden ratio of 10,260 UK pounds per person with learning disability. There is a positive correlation between ratios and levels of net exports of people funded by their local authority social services to reside "out of area". Comparative underspending occurs in rural areas. CONCLUSIONS: There are inequalities in levels of spending on learning disability services. Comparison of regions suggests resources may not be allocated fairly. Health authorities should ensure that population increases are mirrored by appropriate adjustments in expenditure.

Budgets↗
PubMed2005

Tonsillectomy: haemorrhaging ideas.

Tonsil surgery has been described for over 3000 years. Haemorrhage following tonsillectomy remains the most serious complication of surgery. Over recent years several audits have been gathering data on current trends in tonsil surgery and clinical outcomes throughout England, Scotland and Northern Ireland. The results support a return to traditional dissection with ties to reduce the risk of post-operative haemorrhage. We describe the changes that have occurred to improve efficacy and safety during the evolution of the modern tonsillectomy.

Electrocoagulation↗
PubMed2005

Acute care restructuring in Newfoundland and Labrador: the history and impact on expenditure.

OBJECTIVES: To document the history of regionalization and its effects on the Newfoundland and Labrador acute care health system, and to describe changes in acute care expenditure in the St John's region where hospital redesign, closure and aggregation occurred in relation to other regions not exposed to aggregation. METHODS: Interviews were conducted with senior health officials. Transcripts and other reports were reviewed. Financial data were abstracted from audited general ledger statements received from the Ministry of Health. RESULTS: Regionalization achieved its objectives of hospital aggregation in St John's. The average number of full-time equivalent employees increased slightly by 2% (5304-5416). In some regions, integration of services was delayed because of conflict and resistance to change. There was some disparity between the Provincial Government's objectives for cost control and the CEOs' perceptions of economies of scale. Between 1995/96 and 2002/03, total expenditures for the St John's region and the other five regional hospitals increased by 46% and 54%, respectively; total personal income of the population and government revenues increased by only 18% and 16%, respectively. CONCLUSIONS: Regionalization in Newfoundland and Labrador facilitated aggregation of hospitals, but did not control the number of front-line workers and, consequently, total acute care expenditure. Expenditure increased significantly between 1995 and 2002, at a rate which exceeded the increase in government revenues. The government's ability to pay for acute care will not be achieved unless employee costs are controlled or provincial income increases.

Health Care Reform↗
PubMed2004

Feasibility study and methodology to create a quality-evaluated database of primary care data.

OBJECTIVES: To build and test a model for the collection of computerised retrospective primary care data from the UK, and to assess its quality for use in medical and pharmaceutical research. DESIGN: Collection and evaluation of sampled retrospective general practice data recording. SETTING: General practices, using the Vision practice management software in the UK. MAIN OUTCOME MEASURES: Quality indicators of completeness of data recording. RESULTS: Initial audit of 236 practices indicated good recording of prescribing in all practices and a high level of completeness of recording of clinical information in many of the practices. CONCLUSIONS: In the group of practices studied, levels of recording were generally assessed to be of sufficient quality to enable a database of quality-evaluated, anonymised primary care records to be created.

Benchmarking↗
PubMed2004

The impact of multiple pregnancies and malformations on perinatal mortality.

AIM: To evaluate the impact of the rate of multiple pregnancies and congenital malformations on perinatal mortality. METHODS: The study is based on data from the perinatal audit in Vejle County Denmark. Fetal deaths with gestational age > or = 22 weeks and deaths in livebirths within the first 28 days after birth were included in the calculated perinatal mortality. Total number of births was 30,181 and 252 pregnancies and 268 fetuses/infants were evaluated. The study period was 1995-2000. There was no routine ultrasound screening for congenital malformations in the county, though midtrimester ultrasound was used to assess gestational age. RESULTS: Perinatal mortality was 8.9 per 1000 births with no significant change over time. Rate of multiple pregnancies was 1.94% ranging from 1.81% during the first 3 years to 2.06% for the last 3 years (not significant). Fetuses and infants from multiple pregnancies contributed 18% of all deaths. Perinatal mortality for single births was 7.6 per 1000 births and for multiple births 42.2/1000 (P<0.0001). The distribution of gestational age for single and multiple births was highly significant (P<0.0001) with 67% of multiple pregnancies with GA < 28 weeks compared to 26% of single pregnancies. Nineteen percent of all deaths were caused by congenital malformations and the majority of these were potentially detectable by ultrasound investigation. CONCLUSIONS: The increasing rate of multiple pregnancies makes it difficult to see improvements in perinatal mortality. Calculated from the perinatal mortality in single and multiple pregnancies in Vejle County assisted conceptions contribute with an an excess of 45 perinatal deaths per year in Denmark. The difference between countries in rate of multiple pregnancies and in prenatal ultrasound screening recommendations for malformations makes it difficult to compare perinatal mortality.

Abnormalities, Multiple↗
PubMed1986

Limitations of current fetal monitoring technology.

Continuous recordings with a cardiotocograph are confused with the concept of monitoring. One of the continuing problems is ensuring that recordings are properly monitored by the clinical staff. Previous simplistic attempts at producing true monitors which failed to work inhibited the development of more sophisticated approaches which modern technology now make possible. The use of computers in this field would not only reduce the monitoring load on the staff but also have advantages in data storage, data transfer and in audit. The profession has failed to demand, and the manufacturers to offer, the advantages of modern technology which could improve our level of intra-partum care.

Female↗
PubMed2002

A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion.

OBJECTIVE: To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors, we compared the effects of 2 interventions, delivered through pediatric primary care practices. The interventions, based on an office systems' approach, sought to prevent early drinking and smoking or to influence bicycle helmet use, gun storage, and seatbelt safety for children who were followed from fifth/sixth grades through eighth/ninth grades. DESIGN: Settings and Participants. Twelve pediatric practices in New England were paired according to practice size and assigned randomly within pairs to deliver the multicomponent interventions, which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters. INTERVENTION: One intervention arm focused on alcohol and tobacco use. The other intervention arm focused on gun safety, bicycle helmet, and seatbelt use. Office systems provided infrastructure that supported the clinician's role. Clinician messages encouraged family communication and rule setting about the issues of the middle school years. The intervention was initiated during a health supervision visit and continued for 36 months. Both child and parent received quarterly newsletters to reinforce the clinician messages. OUTCOME MEASURES: The primary outcomes were ever drinking alcohol, ever smoking, ever using smokeless tobacco, using a bicycle helmet in the previous year, using a seatbelt in the previous 30 days, and guns in the child's home in locked storage. RESULTS: The pediatric practices recruited 85% (N = 3525) of the practices' fifth/sixth grade children and their responding parents. We obtained 36 months' follow-up data on 2183 child-parent pairs. Chart audit verified that the intervention was implemented. Additional data from interviews and surveys showed that parents, children, and pediatric clinicians found the intervention useful. Despite this, comparisons between the 2 study arms show no significant intervention effects in the prevention of alcohol and tobacco use or gun storage or seatbelt safety. There was a negative effect in the alcohol arm. Only bicycle helmet use showed a positive outcome. CONCLUSION: With rigorous evaluation, 2 office interventions failed to produce desired outcomes. Coordinated multiple settings for prevention interventions are probably necessary.

Adolescent↗
PubMed2026

Multimodal artificial intelligence and machine learning in oncology: from data integration to precision cancer care.

Cancer remains a major global health burden, with approximately 20 million new cases and 9.7 million cancer-related deaths reported globally in 2022. While advances in radiological imaging, molecular profiling, and clinical data have enhanced the interpretation of disease progression, the availability of multiple such modalities still does not meet the needs of a large patient population. This narrative review focuses on the role of multimodal artificial intelligence and machine learning in bridging the gap in interpreting heterogeneous modalities to improve risk prediction, prognostic assessment, and treatment decision-making in precision oncology. Multimodal frameworks such as Pathomic Fusion illustrate how complementary histopathological and genomic information can be integrated for cancer diagnosis and prognostic modeling. Multimodal models have demonstrated potential in virtual biopsy, cancer screening, prognostic prediction, radiotherapy planning, intraoperative guidance, and clinical-trial design using digital twins and synthetic control arms. The major limitations of incorporating multimodal artificial intelligence and machine learning in oncology include data heterogeneity, demographic or institutional biases, and reproducibility challenges that hinder translation. Accordingly, appropriate data-governance strategies, fairness audits, and privacy-preserving approaches such as federated learning should be considered where appropriate. Future progress will depend on the development of standardized benchmarking datasets, robust external validation, seamless integration with electronic health records and picture archiving and communication systems, and the implementation of explainable, secure, and clinically validated multimodal artificial intelligence frameworks that support precision oncology in routine clinical practice.

deep learning↗
PubMed1999

Analysis of pill knowledge amongst oral contraceptive users in Scotland according to client characteristics.

OBJECTIVES: The primary objective of this study was to investigate the relationship between various client characteristics and knowledge of oral contraceptives amongst pill users. METHOD: This was a subanalysis of the data from the national audit of Scottish family planning clinics. RESULTS: There were significant differences in knowledge about many different criteria according to the characteristics of the client group. Low educational attainment, unemployment and more rural residence produced greater significant differences in contraception knowledge than social deprivation according to postcode (zipcode). Age and duration of use affected different criteria to varying degrees, but teenagers scored relatively poorly compared to the general population and knowledge did not significantly improve overall with duration of use. CONCLUSION: Client characteristics do affect levels of pill knowledge. Clinicians must reflect on how to communicate more effectively with all types of pill users. They should take the opportunity of clinic visits for repeat pill prescriptions to improve knowledge levels.

Adolescent↗
PubMed1999

The pharmaceutical industry and oncology in central and eastern Europe.

Major opportunities exist for patients, investigators and the pharmaceutical industry in oncology drug development in Central and Eastern Europe. Novel therapeutics may be offered for investigational use in selected centres capable of adherence to Good Clinical Practice (GCP). Requirements for participation in oncology clinical trials include the availability of experienced qualified investigators highly motivated to conform with the principles of GCP (International Harmonization (ICH) guidelines); availability of appropriate Institutional Review Board for Human Subjects (IRB), access to appropriate patient populations, access to individual patient data, acceptance of possible audit by sponsoring companies and the Food and Drug Administration (FDA), and a willingness to participate in the generation of new knowledge. Patients gain through access to novel therapeutics. We have had success in performing clinical trials to international standards in Central and Eastern Europe. This experience will be described.

Antineoplastic Agents↗
PubMed2002

Initial infant feeding decisions and duration of breastfeeding in women from English, Arabic and Chinese-speaking backgrounds in Australia.

Anecdotally, concerns are often expressed about the varying infant feeding decisions among women from different cultural groups. This paper reports the early infant feeding decisions and duration of breastfeeding in 986 women from English, Chinese and Arabic-speaking backgrounds in Sydney during 1997 and 1998. Data were collectedfrom an audit of medical records and through a questionnaire at eight weeks postpartum. Chinese-speaking women were less likely to express an intention to breastfeed and fewer initiated breastfeeding compared with other women. Arabic-speaking women had significantly longer duration rates compared with other women. A greater proportion of the Chinese-speaking women who initiated breastfeeding were still breastfeeding at eight weeks compared with English-speaking women. This study suggests that there are differences in the infant feeding decisions between English, Arabic and Chinese-speaking women. Clinicians need to further understand cultural differences when providing care, education and support in a multicultural context.

Adult↗
PubMed2002

Gastro-oesophageal cancer: facts, myths and surgical folk lore.

The prognosis of patients with gastric and oesophageal cancers remains poor but increased knowledge of the factors involved in carcinogenesis and a better understanding of the disease process has led to strategies to improve outcomes. These are discussed under the following headings: (1) Prevention of the disease, (2) early detection of tumours, (3) treatment selection and (4) treatment. The likely impact of developments in each of these areas is considered in relation to population-based data from the Scottish Audit of Gastro-Oesophageal Cancer (SAGOC). Although there are a number of novel developments in the management of gastric and oesophageal cancer it is only by the conduct of controlled trials that the value of these will be determined. More immediate improvements in patient care may be derived from rationalisation of existing resources to ensure that all patients benefit from early diagnosis, the appropriate selection and delivery of treatment. One model of care, which may ensure this is the development of managed clinical networks, would maintain the involvement of all units in the management and treatment of upper GI cancers to a level that is possible with the facilities available. At the same time the patients requiring more specialised treatment would benefit from established referral networks

Esophageal Neoplasms↗