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PubMed1996

The use of administrative data as the first step in the continuous quality improvement process.

Billing or claims data, commonly referred to as administrative data, can be a valuable tool as the first step in a continuous quality improvement process. It is an inexpensive source of information which allows providers to identify opportunities for improvement in the process and the outcomes of health care delivery. The All Patient Refined/Diagnosis-Related Group case mix or severity-adjusted data represents one tool. The Practice Review System of Value Health Sciences is another. Comparative information is the first step, and the first step only in the quality improvement process. As such, to meet the needs of all continuous quality improvement customers, it is necessary to make this first step as reliable, yet inexpensive, as possible. Completing all the steps requires the use of a several measures over time.

Comorbidity↗

PubMed2006

The clinical document architecture and the continuity of care record: a critical analysis.

Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International.

Computer Communication Networks↗

PubMed2002

Collaboration by use of the Internet yields data of high quality and detects non-uniform management of patients with Helicobacter pylori infection.

BACKGROUND: The benefits of new technology steadily being introduced in medicine should be documented. In this study, remote entry of a set of data from the daily routine was submitted via the Internet to a common database. The usefulness and quality of the information are evaluated. METHODS: Fourteen hospitals reported a common data set on consecutive Hp+ve patients handled in accordance with daily practice. Participants submitted their data via the Internet to a database. There was no monitoring or other surveillance. No audit was planned or expected, but was nevertheless possible. Doctor compliance with the common agreement was checked, differences in medical practice were noted and quality was assessed comparing the most important source data with the data in the final database. RESULTS: Four-hundred-and-forty patients were included. The quality of the reported data was high, only 1.3% showing a discrepancy between source data and the database. Overall treatment success was 89%, with no significant differences between hospitals. There were significant differences in clinical practice between the centres, the proportion of patients treated for ulcer disease varying from 36% to 96% (P < 0.001). Doctor compliance with the agreed collaboration varied significantly (P < 0.001). CONCLUSION: Internet collaboration through remote data entry in a common database yields data of high quality without monitoring, and is a powerful and resource economic tool for clinical multicentre trials and quality assurance.

Clinical Trials as Topic↗

PubMed1995

Telemedicine system evaluation and a collaborative model for multi-centered research.

Evaluating telemedicine systems and services is a complex task. Safety and efficacy must be measured in a relatively controlled laboratory environment, while measurement of clinical utility and medical effectiveness requires extensive field testing. The need for large clinical trials to demonstrate utility and effectiveness presents a dilemma. Substantial numbers of cases are needed to achieve statistically valid results, yet most telemedicine programs are based in rural settings with small patient populations. One potential solution is to pool data from multiple programs by using common data collection instruments and protocols. A promising model for the performance of multi-centered collaborative telemedicine research is described. The Clinical Telemedicine Cooperative Group (CTCG) is based on the successful use of collaborative research by clinical oncology research groups such as the Southwest Oncology Group (SWOG).

Cost-Benefit Analysis↗

PubMed2001

Estimating log models: to transform or not to transform?

Health economists often use log models to deal with skewed outcomes, such as health utilization or health expenditures. The literature provides a number of alternative estimation approaches for log models, including ordinary least-squares on ln(y) and generalized linear models. This study examines how well the alternative estimators behave econometrically in terms of bias and precision when the data are skewed or have other common data problems (heteroscedasticity, heavy tails, etc.). No single alternative is best under all conditions examined. The paper provides a straightforward algorithm for choosing among the alternative estimators. Even if the estimators considered are consistent, there can be major losses in precision from selecting a less appropriate estimator.

Delivery of Health Care, Integrated↗

PubMed2003

Multipoint and single point non-parametric linkage analysis with imperfect data.

We used simulation to explore the impact of common data imperfections (i.e., missing parents, genotyping error, map error, and missing genotypes) upon the performance of multipoint and single point linkage analysis in the analyses of linkage data from pairs of siblings affected with an idealized complex trait. The performance of single point and multipoint linkage was similar under an unrealistic best case scenario; however, when four data imperfections were combined, the performance of single point linkage analysis appeared to be superior to multipoint. The absence of parental genotypes in the presence of 1% genotype error led to marked degradation of linkage signal, particularly for multipoint analyses.

Computer Simulation↗

PubMed2006

Validation of the Provincial Transfer Authorization Centre database: a comprehensive database containing records of all inter-facility patient transfers in the province of Ontario.

BACKGROUND: The Provincial Transfer Authorization Centre (PTAC) was established as a part of the emergency response in Ontario, Canada to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Prior to 2003, data relating to inter-facility patient transfers were not collected in a systematic manner. Then, in an emergency setting, a comprehensive database with a complex data collection process was established. For the first time in Ontario, population-based data for patient movement between healthcare facilities for a population of twelve million are available. The PTAC database stores all patient transfer data in a large database. There are few population-based patient transfer databases and the PTAC database is believed to be the largest example to house this novel dataset. A patient transfer database has also never been validated. This paper presents the validation of the PTAC database. METHODS: A random sample of 100 patient inter-facility transfer records was compared to the corresponding institutional patient records from the sending healthcare facilities. Measures of agreement, including sensitivity, were calculated for the 12 common data variables. RESULTS: Of the 100 randomly selected patient transfer records, 95 (95%) of the corresponding institutional patient records were located. Data variables in the categories patient demographics, facility identification and timing of transfer and reason and urgency of transfer had strong agreement levels. The 10 most commonly used data variables had accuracy rates that ranged from 85.3% to 100% and error rates ranging from 0 to 12.6%. These same variables had sensitivity values ranging from 0.87 to 1.0. CONCLUSION: The very high level of agreement between institutional patient records and the PTAC data for fields compared in this study supports the validity of the PTAC database. For the first time, a population-based patient transfer database has been established. Although it was created during an emergency situation and data collection is dependent on front-line medical workers, the PTAC data has achieved a high level of validity, perhaps even higher than many purpose built databases created during non-emergency settings.

Database Management Systems↗

PubMed2001

Osmotic perturbations induce differential movements in the core and periphery of proteins, membranes and micelles.

Polymeric structures, namely, micelles, membranes and globular proteins share the property of two distinct regions: a hydrophobic core and a hydrophilic exterior. The dynamics of these regions of the polymeric structures were probed using selective fluorophores 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-anilinonaphthalene-8-sulfonate (ANS), respectively. Perturbation of the polymers by external osmotic pressure, ionic strength and temperature was monitored in the two regions using steady state measurements of fluorescence intensity and anisotropy. While the fluorescence lifetime of DPH and ANS did not change significantly, parallel change in steady state anisotropy values and the rotational correlation time indicated mobility in the probe/probe-domain. Osmotic perturbation of the polymers in electrolyte media led to decreased DPH mobility. Enhanced ellipticity at 222 nm in bovine serum albumin was observed in 1.5 M NaCl and sucrose media. ANS exhibited a decreased anisotropy with progressive dehydration in proteins in NaCl media, in dimyristoylphosphatidylcholine (DMPC) vesicles in sucrose media, and in neutral laurylmaltoside micelles in both NaCl and sucrose media. Thus, ANS showed responses opposite to that of DPH in these systems. A comparison with several domain selective probes indicated that DPH reported findings common to depth probes while ANS reported data common to interfacial probes used for voltage monitoring.

Anilino Naphthalenesulfonates↗

PubMed2001

[Quality assurance of data collection and data processing in epidemiologic study data].

Quality assurance of the data generating processes in epidemiologic studies is a prerequisite for the internal validity of study results. This paper presents practical aspects of such a quality assurance system pertaining to the planning, data gathering, data entry and data processing phase of a study. It is concerned with data obtained in the framework of a project rather than with data accumulating continuously in private practices, research institutes or veterinary faculties. During the planning phase of a project, standard operating protocols should be developed that assure a reliable performance of observation, coding and data entry. The data base structure, consisting of tables, input validation rules and queries, should be predefined and well documented. A data safety concept will provide the necessary integrity, physical safety and availability of the data. The paper presents technical solutions to common data processing problems with emphasis on re-coding and relational data base facilities (Microsoft-ACCESS) using a hypothetical study on risk factors for mastitis.

Animals↗

PubMed2005

Global Tobacco Surveillance System (GTSS): purpose, production, and potential.

The World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Canadian Public Health Association (CPHA) developed the Global Tobacco Surveillance System (GTSS) to assist all 192 WHO Member States in collecting data on youth and adult tobacco use. The flexible GTSS system includes common data items but allows countries to include important unique information at their discretion. It uses a common survey methodology, similar field procedures for data collection, and similar data management and processing techniques. The GTSS includes collection of data through three surveys: the Global Youth Tobacco Survey (GYTS) for youth, and the Global School Personnel Survey (GSPS) and the Global Health Professional Survey (GHPS) for adults. GTSS data potentially can be applied in four ways. First, countries and research partners can disseminate data through publications, presentations, and an active GTSS web site. Second, countries can use GTSS data to inform politicians about the tobacco problem in their country, leading to new policy decisions to prevent and control tobacco use. Third, GTSS can provide countries with valuable feedback to evaluate and improve Country National Action Plans or develop new plans. Fourth, in response to the WHO FCTC call for countries to use consistent methods and procedures in their surveillance efforts, GTSS offers such consistency in sampling procedures, core questionnaire items, training infield procedures, and analysis of data across all survey sites. The GTSS represents the most comprehensive tobacco surveillance system ever developed and implemented. As an example, this paper describes development of the GYTS and discusses potential uses of the data. Sample data were drawn from 38 sites in 24 countries in the African Region, 82 sites in 35 countries in the Americas Region, 20 sites in 17 countries and the Gaza Strip/West Bank region in the Eastern Mediterranean Region, 25 sites in 22 countries in the European Region, 34 sites in six countries in the Southeast Asia Region, and 25 sites in 14 countries in the Western Pacific Region.

Adolescent↗

PubMed1977

Accelerographic, temporal, and distance gait factors in below-knee amputees.

Gait characteristics of 19 patients with a unilateral below-knee amputation were studied. The accelerographic and foot placement method used in this study allowed for simultaneous acquisition of data commonly obtained in the experimental laboratory (acceleration) and data easily gathered in the physical therapy clinic (temporal and distance factors). The following results may be of interest to the clinician: 1) measures of cadence, stride length, and velocity were highly related and the magnitude of these measures was below commonly accepted values for normal; 2) the below-knee amputees spent more time in stance phase on their uninvolved lower extremity than on their involved (prosthetic) extemity; 3) the step length from heel strike of the uninvolved lower extremity to heel strike of the involved (prosthetic) lower extremity was greater and accomplished in less time than the opposite step; and 4) smoothness of the gait pattern and any single temporal and distance factor exhibited low statistical relationships.

Acceleration↗

PubMedDate not supplied

Structure elucidation from 2D NMR spectra using the StrucEluc expert system: detection and removal of contradictions in the data.

The elucidation of chemical structures from 2D NMR data commonly utilizes a combination of COSY, HMQC/HSQC, and HMBC data. Generally COSY connectivities are assumed to mostly describe the separation of protons that are separated by 1 skeletal bond (3JHH), while HMBC connectivities represent protons separated from carbon atoms by 1 to 2 skeletal bonds (2JCH and 3JCH). Obviously COSY and HMBC connectivities of lengths greater than those described have been detected. Though experimental techniques have recently been described to aid in the identification of the nature of the couplings the detection of whether a coupling is 2-bond or greater still remains a challenge in most laboratories. In the StrucEluc software system the common lengths of the connectivities, 1-bond for COSY and 1- or 2-bond for HMBC, derived from 2D NMR data are set as the default. Therefore, in the presence of any extended connectivities contradictions can appear in the 2D NMR data. In this article, algorithmic methods for the detection and removal of contradictions in 2D NMR data that have been developed in support of StrucEluc are described. The methods are based on the analysis of molecular connectivity diagrams, MCDs. These methods have been implemented in the StrucEluc system and tested by solving 50 structural problems with 2D NMR spectral data containing contradictions. The presence of contradictions was detected by the algorithm in 90% of the cases, and the contradictions were automatically removed in approximately 50% of the problems. A method of "fuzzy" structure generation in the presence of contradictions has been suggested and successfully tested in this work. This work will demonstrate examples of the application of developed methods to a number of structural problems.

Journal Article↗

PubMed1999

The effects of socioeconomic status and dental attendance on dental caries' experience, and treatment patterns in 5-year-old children.

OBJECTIVE: To compare the dental caries' experience and treatment received by 5-year-old children registered with a GDP. DESIGN: Retrospective case note review of all 5-year-old children registered with seven GDPs. SETTING: The study was carried out in 1996/7 in Wirral and North Cheshire in the north west of England. SUBJECTS AND MATERIALS: Clinical, demographic and attendance data were collected from each practice using a common data abstraction form. Subjects were categorised according to regular/irregular attenders, and into five groups ranging from affluent to deprived using the Super Profiles geodemographic classification. The relationships between disease experience, treatment, attendance and socioeconomic status were compared using cross-tabulations, t-tests and multiple linear regression. RESULTS: The dental records of 430 5-year-old children were available for analysis. Irregular attenders had significantly higher dmft, dt and mt, and fewer filled teeth. Only 29% of disease experience of regular attenders was treated by restoration. Both socioeconomic status and visiting behaviour exerted significant independent effects on dmft, but dental attendance alone had a significant effect on ft. CONCLUSIONS: Significant inequalities remain in the disease experience and service use of young children. Regularly attending children have less than a third of their diseased teeth restored. Consensus is needed across the profession on the care of the diseased deciduous dentition.

Child, Preschool↗

PubMed2006

[Data collection for quality assurance in neonatology: how do physicians compare to documentation specialists?].

BACKGROUND: The quality of data collected for the German nationwide quality assurance program in neonatology is currently unknown. The aim of this study was to compare the quality of data collected by resident physicians with the quality of similar data collected by a dedicated research nurse. METHODS: Data for the German national quality assurance program in neonatology, derived from a cohort of 128 premature newborns with a birth weight <1500 g and/or a gestational age of <30 weeks born in the year 2003, were collected by residents taking care on these patients, and separately by a dedicated research nurse for the European Neonatal Network (EuroNeoNet). The data set collected for both networks included 44 common data items. The two data sets were compared, and any disagreement was double-checked using the chart of the baby to clarify which of the data entries was wrong. Furthermore, as data items are not equally important, a weighted analysis of all mistakes was performed. RESULTS: We found wrong data in 108/128 (84 %) of the data sets collected by the residents, and in 43/128 (34 %) of the data sets collected by the research nurse (p < 0.001). The weighted analysis revealed that residents made more mistakes in 30/44 of collected data items, whereas the research nurse did worse only in 1/44 data items. CONCLUSION: This study shows that the quality of data obtained by our resident physicians was worse than the quality of data obtained by our dedicated research nurse.

Clinical Nursing Research↗

PubMed2000

Benchmarking medical group practices using claims data: methodological and practical problems.

As claims data for physicians and groups of physicians has improved in quality and quantity, health information vendors have begun marketing information about medical groups' productivity, utilization, and quality. Based on interviews with product developers and our understanding of the evolution of their products, several methodological and practical issues remain. For now and the immediate future, health information vendors will continue to face the limitations of physicians' claims data. Vendors and purchasers should be aware of common data shortcomings such as inadequate monthly enrollment figures, possible physician upcoding to circumvent utilization management restrictions, and incorrect coding when a test is used to rule out a disease. In the longer term, several avenues seem likely to make medical groups' data better and richer because of computer-based medical records and efficiencies possible from the Internet. The field of benchmarking products for group practices is still an immature market. However, several trends suggest such products are highly desirable. Provider organizations which bear medical risk need benchmarking data to help improve their efficiency. There are many important nonprovider organizations that need good information on group practices' utilization patterns and outcomes to help them plan new products and negotiate with physicians.

Benchmarking↗

PubMed1997

[Target population for hypertensive therapy].

The efficacy of treatment may be demonstrated globally but, in some patients, treatment can be either inappropriate or harmful because of undesirable secondary effects. Ideally, treatment should be limited to patients who respond, but this is impossible with the published data from clinical trials. This could become possible by creating a data base containing all published results and carrying out meta analyses on individual parameters. Using the most powerful methods of analysis this could allow identification of patients responding to treatment by taking into account not only the benefits but also the risks of a given treatment (the principle is to identify and estimate factors--demographical, sociological, generic, which interfere with the size of the effect). In order to identify responders to antihypertensive treatment, a meta analysis of individual data was started, the INDANA project. With a common data base of all the preventive trials of antihypertensive therapy, this study should contribute to improved identification of responders and therefore to individualization of treatment of hypertension.

Antihypertensive Agents↗

PubMed1992

Clinical semiology of common cervicobrachial neuralgia. Data from 50 hospital cases.

Common cervicobrachial neuralgia is less frequent than sciatica and its aetiological profile is more varied: men and women are equally affected, triggering factors or previous history are less often found and patients with anxiety or depression are relatively numerous. Clinically, signs of C7 lesion are present in half the patients. Acroparesthesias are frequent and may be the initial signs. Nocturnal pain is present in 50% of the cases. Signs of neurological deficit are rare, except for abolition of a reflex. The association of cervicobrachial neuralgia with tendinitis of the upper limb or algodystrophy of the shoulder is too frequent to be fortuitous. Left to itself, the syndrome usually lasts several months and sometimes one year. Recurrences are rare. The most frequent sequela is a painful neck.

Brachial Plexus Neuritis↗

PubMed1998

Zopiclone. An update of its pharmacology, clinical efficacy and tolerability in the treatment of insomnia.

Zopiclone is a non-benzodiazepine hypnotic which was first reviewed in Drugs in 1986. At that time, zopiclone had shown hypnotic efficacy superior to that of placebo, but had not been extensively compared with benzodiazepine hypnotics in patients with insomnia. A much larger body of clinical data is now available, allowing a more detailed evaluation than was previously possible. Together with results from earlier studies, subsequent clinical trials have shown that zopiclone is generally at least as effective as the benzodiazepines (regardless of duration of action) in the treatment of insomnia, although comparisons between zopiclone and flurazepam have produced inconsistent results. Tolerance to the effects of zopiclone was not seen in short term clinical trials (< or = 4 weeks); data from longer term studies are conflicting and the potential for tolerance during long term zopiclone treatment is therefore unclear. Zopiclone has a relatively low propensity to cause residual clinical effects (such as difficulty in waking or reduced morning concentration). Rebound of insomnia to a level below that at baseline can occur after withdrawal of zopiclone, but, on the basis of data from short term studies, does not appear to be common. Data from prescription-event monitoring suggest that zopiclone does not have a high dependence potential (at least in those who are not regular drug abusers/addicts). Zopiclone is well tolerated in both the elderly and younger patients with insomnia. A bitter aftertaste is usually the most common adverse event, but is relatively infrequent (3.6% in the largest available postmarketing study). Thus, zopiclone is now firmly established as an effective and well tolerated hypnotic agent. Although the available data on rebound insomnia and dependence liability are encouraging, potential differences between zopiclone and the benzodiazepines in these respects may have little clinical relevance in the context of short term intermittent use of hypnotics, as it currently recommended. A low propensity for rebound insomnia and dependence might prove valuable during long term hypnotic therapy (which, although not recommended, is a clinical reality). However, the risk-benefit profile of zopiclone in this context remains unknown. Nevertheless, zopiclone is clearly a suitable alternative to the benzodiazepines for the short term treatment of insomnia.

Azabicyclo Compounds↗