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PubMed2003

[Medical care research based on family doctor routine data--are interface-communicated treatment data feasible?].

AIMS OF THE STUDY: As part of an ongoing project on the utilisation of generic drugs in general practice we aimed at determining whether the transfer of prescriptions and patient characteristics from doctors' computerized medical records via the BDT (Behandlungsdatenträger) interface was feasible, and whether these data are suitable for research in pharmacoepidemiology. METHODS: All 1,395 general practitioners from 6 regions in Germany were invited to participate in the 'generics project'; 232 (17 %) agreed. The 17 software companies whose systems were used by the participating practices were asked to grant access to the BDT interface. For a prescription survey, doctors were supposed to export BDT files from two 3-month periods each in 2000 and 2001. Data were anonymised and relevant information extracted with a special programme. RESULTS: So far, BDT data are available from 79 practices. They are suitable for practice- and patient-related prescribing analyses. By filter modifications, additional information (such as diagnoses, referrals, clinical findings or accounting codes) can be obtained. The procedure was well accepted if doctors and practice staff were assisted by computer experts. Some difficulties, however, were encountered in obtaining access to the BDT-interface from the software companies. Lack of standardisation of the BDT interface required additional conditioning of the data. CONCLUSION: The BDT interface offers an opportunity to export computerised patient records without the requirement of additional documentation. If routine data are more readily available for health services research, a standardised data structure and open access must be assured e. g. by centralised certification via the Federal statutory health organisation.

Data Collection↗
PubMed1996

[Development of a clinical-radiological CD-ROM database for focal lesions of the liver].

PURPOSE: The development of a CD-ROM database for continuous acquisition and archiving of interesting radiologic cases is described. As a pilot study radiologic images of focal lesions of the liver were collected. METHODS: The database runs on a PC (80486 DX2, 66 MHz, 16 MB RAM), which is connected to the clinic network, a high quality x-ray scanner and a CD-ROM writer. Radiologic images can be inserted into the database either by scanner or by image transfer via network. The database is designed using Access 2.0. Well documented cases were chosen retrospectively, manipulated and archived. RESULTS: 308 images of 12 focal lesions with a capacity of 802 MB were stored on CD-ROM. Per case a storage capacity of 40-75 MB is necessary for image raw material, 15-25 MB are necessary for the postprocessed data. Spatial resolution is 190 dpi (3000 pixel/40 cm). Clinical data, radiological diagnosis coded by modified ACR index and a compressed icon of the images are stored on PC, the image data are stored on CD-ROM. 2.5 hours per case are needed for the complete acquisition, manipulation and archiving procedure, but improved hardware configuration can reduce the time significantly. CONCLUSION: The described database allows continuous archiving of interesting radiologic cases on PC. ACR index is suited for a quick search of a specific combination of radiologic images and diagnosis from different modalities.

Angiography↗
PubMed2001

Novel rhodopsin mutation in a Chinese family with autosomal dominant retinitis pigmentosa.

PURPOSE: To identify mutations in the rhodopsin (RHO) gene in Chinese patients with autosomal dominant retinitis pigmentosa (ADRP) and to measure the prevalence rate of RHO mutations in Chinese ADRP cases. METHODS: Thirteen Chinese families with ADRP were clinically characterized. The complete coding region and intron splice sites of RHO were analyzed for mutations with single-strand conformation polymorphism (SSCP) analysis and direct genomic sequencing. RESULTS: One of the 13 Chinese families with ADRP was found to have a new, previously unidentified RHO mutation, a change from GAG to TAG at codon 341. The mutation (E341X) results in an in-frame stop codon, leading to the truncation of the rhodopsin protein. Mutation E341X was not detected in 100 normal control individuals. Patients carrying mutation E341X reported night blindness and showed optic atrophy, vessel attenuation, and a few bone spicule-like pigments in peripheral retina at the age of 23-25 years. At the age of 30 years, visual acuity was severely impaired, peripheral visual field was greatly constricted, rod and cone ERG was not detectable, and only a slight left cone response remained. CONCLUSIONS: We have identified a novel rhodopsin mutation (E341X) in a Chinese family with ADRP. The location and character of the mutation expand the spectrum of RHO mutations causing RP. Identification of a RHO mutation in one of the 13 ADRP families studied suggests that only 7.7% of the ADRP cases in a Chinese population were caused by RHO mutations, a ratio significantly lower than that from North America or Europe.

Adult↗
PubMed1992

Molecular epidemiology of envelope glycoprotein H of human cytomegalovirus.

The complete envelope glycoprotein H (gH) coding sequences of 10 clinical strains of cytomegalovirus (CMV) were determined and compared with those of laboratory strains AD169 and Towne. Their translated peptide sequences segregated into two groups, exemplified by AD169 and Towne. Peptide variation was mostly group-specific and was clustered in the first 37 amino acids, including the signal sequence; in the rest of the molecule, there were scattered amino acid substitutions, usually in single residues. Compared with CMV envelope glycoprotein B, gH is more highly conserved among strains and may be expected to have limited immunologic diversity.

Amino Acid Sequence↗
PubMed1999

The impact of the 1993 AIDS case definition on the completeness and timeliness of AIDS surveillance.

OBJECTIVE: To assess the impact of the 1993 change in the AIDS case definition on the completeness and timeframe of AIDS case reporting in San Francisco. DESIGN: Retrospective review of records: billing records, list of selected diagnostic codes, radiology logs, ophthalmology clinic records, and patient registries at a selection of hospitals, clinics, and physician offices. SETTING: Hospitals, public/community health clinics, and physician offices. MAIN OUTCOME MEASURES: The completeness of reporting and the median reporting delay was calculated for hospitals, clinics, and physician offices. RESULTS: Reporting was 97% complete. Reporting from physician offices was less complete (75%) than from other facilities. The median reporting delay was 1 month and was shorter for persons who met the 1993 AIDS case definition (1 month) than for persons who met the 1987 case definition (3 months). CONCLUSIONS: AIDS case reporting in San Francisco is highly complete but less so for persons diagnosed at physician offices. The 1993 AIDS case definition has resulted in more timely reporting. Health departments should consider efforts to improve reporting from private physician offices and should evaluate the use of laboratory-initiated CD4 reporting.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Endovascular stenting in patients with Iliac compression syndrome. Experience in three cases.

The authors report their experience in the percutaneous treatment of the iliac compression syndrome in three women (20-53 years old) with acute iliofemoral deep venous thrombosis; in one case, there was an additional thrombus in the inferior caval vein. They were treated by percutaneous implantation of Palmaz stents in the left common iliac vein 1 day after surgical thrombectomy and construction of an arterial venous fistula. All patients showed marked improvement, as determined from venograms obtained immediately after stent implantation. The arteriovenous fistulae were closed 3 months later. At 6 months follow-up, the median clinical and color-coded duplex ultrasound indicates that all stents are patent and all patients are free of symptoms.

Adult↗
PubMed1998

Preferential benefit of implementation of a statewide trauma system in one of two adjacent states.

BACKGROUND: Implementation of Oregon's trauma system was associated with a reduction in the risk of death for hospitalized injured patients. An alternative explanation for improved outcome, however, is favorable concurrent temporal trends, e.g., new technologies and treatments. PATIENTS AND METHODS: To control for temporal trends, seriously injured hospitalized patients in Oregon and Washington were compared before either state had a trauma system (1985-1988) and when only the Oregon trauma system had been implemented (1990-1993). The study group consisted of hospitalized injured patients aged 16 to 79 years with one or more index injuries in six body regions, i.e., head, chest, spleen/liver, femur or pelvis fracture, and burns. Hospital discharge claims data were analyzed, converting International Classification of Diseases, Ninth Revision, Clinical Modification, discharge diagnosis codes to Abbreviated Injury Scale scores and Injury Severity Scores using a conversion algorithm. Multivariate logistic regression models were used to estimate the differential risk-adjusted odds of death in Oregon compared with Washington after adjustment for demographics, injury type, and injury severity. RESULTS: Findings indicated no difference in the risk-adjusted odds of death between Oregon and Washington while both states functioned under an ad hoc trauma system (1985-1988). A significant reduction in the risk of death, however, was noted in Oregon for patients with an index injury and an Injury Severity Score > 15 compared with Washington (adjusted odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.70-0.91) after trauma system implementation in Oregon (1990-1993). Specifically, reductions in the risk of death were demonstrated for patients with head injuries (adjusted OR = 0.70, 95% CI = 0.59-0.82) or liver/spleen injuries (adjusted OR = 0.73, 95% CI = 0.54-0.99). CONCLUSION: Assuming that the two states demonstrated similar concurrent temporal trends, the findings support the conclusion that improved outcomes among injured patients in Oregon may be attributed to the institution of a statewide trauma system.

Abbreviated Injury Scale↗
PubMed2004

Septicemia in the United States dialysis population, 1991 to 1999.

The clinical epidemiology of septicemia in dialysis populations remains poorly defined. In this historical cohort study of 393,451 U.S. dialysis patients, International Classification of Disease, Ninth Revision, Clinical Modification discharge diagnosis codes were used to compare first-year septicemia admission rates in annual incident cohorts from 1991 to 1999 and to calculate subsequent cardiovascular event and mortality rates. Hemodialysis (compared with peritoneal dialysis) as initial therapy and starting dialysis in more recent years were the principal antecedents of septicemia. In hemodialysis patients, adjusted first admission rates (expressed throughout as first episodes per 100 patient-years) rose by 51%, from 11.6 in 1991 to 17.5 in 1999. In peritoneal dialysis patients, rates rose from 5.7 in 1991, peaked at 9.2 in 1997, and declined to 8.0 in 1999. Mortality rates after septicemia were similar to mortality rates after major cardiovascular events. Septicemia was associated with developing myocardial infarction, congestive heart failure, stroke, and peripheral vascular disease with adjusted risk ratios of 4.1, 5.5, 4.1, and 3.8 in the initial 6 mo after admission for septicemia and 1.7, 2.0, 2.0, and 1.6 after 5 yr, respectively. Septicemia, which is associated with increased cardiovascular and death risk, has become more common in dialysis patients in the United States.

Adult↗
PubMed2005

Effective treatment of biliary cystadenoma.

OBJECTIVE: Evaluate experience over 15 years with treatment of this lesion. SUMMARY BACKGROUND DATA: Biliary cystadenoma, a benign hepatic tumor arising from Von Meyenberg complexes, usually present as septated intrahepatic cystic lesions. METHODS: Data were collected concurrently and retrospectively on patients identified from hospital medical records reviewed for pertinent International Classification of Diseases, Ninth Revision, Clinical Modification and CPT codes, pathology logs, and from operative case logs. Pathology specimens were rereviewed to confirm the diagnosis of biliary cystadenoma or biliary cystadenocarcinoma by 2 GI pathologists. RESULTS: From October 1989 to April 2004 at our institution, 19 (18F:1M) patients had pathologically confirmed biliary cystadenomas, including one with a biliary cystadenocarcinoma. The mean age was 48 +/- 15 years at initial evaluation. Complaints included abdominal pain in 74%, abdominal distension in 26%, and nausea/vomiting in 11%. Only 1 patient presented with an incidental finding. Symptoms had been present for 3 +/- 5 years, with 1 to 4 different surgeons and many other physicians involved in the diagnosis or treatment prior to definitive ablation. Eight patients had undergone 20 previous treatments, including multiple percutaneous aspirations in 4 and 11 operative procedures. CT or US was diagnostic in 95%, with internal septations present in the hepatic cysts. Definitive operative intervention consisted of hepatic resection in 12 patients, enucleation in 6 patients, and fenestration and complete fulguration in 1 patient. There were no perioperative deaths. No recurrences were observed after definitive therapy, with follow-up of 4 +/- 4 years. CONCLUSIONS: Biliary cystadenoma must be recognized and treated differently than most hepatic cysts. There remains a need for education about the imaging findings for biliary cystadenoma to reduce the demonstrated delay in appropriate treatment. Traditional treatment of simple cysts such as aspiration, drainage, and marsupialization results in near universal recurrence and occasional malignant degeneration. This experience demonstrates effective options include total ablation by standard hepatic resection and cyst enucleation.

Adult↗
PubMed2004

Hospital factors associated with splenectomy for splenic injury: a national perspective.

BACKGROUND: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. METHODS: Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. RESULTS: Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. CONCLUSION: The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.

Abdominal Injuries↗
PubMed1987

Antigenic variants of Colorado tick fever virus.

Twenty strains of Colorado tick fever (CTF) virus, isolated from ticks, mammals and humans, and two antigenic relatives of CTF virus were compared in cross-neutralization tests. Viruses were tested using single-inoculation sera prepared in hamsters. Antigenic variation, as measured by differences detected in the neutralization test, was noted among the virus isolates identified as strains of CTF virus. The virus strains isolated from humans appeared to vary the most in serological reactions. The two antigenic relatives of CTF virus are clearly distinct from strains of CTF and are different from each other. Antigenic relationships between these two viruses were established using two sets of single-inoculation antisera and both complement fixation and neutralization tests. Six distinct antigenic variants of CTF virus isolated from humans and the virus strain from ticks (75V1906) that showed the least antigenic variation, were tested against 49 coded serum pairs from clinically diagnosed cases of CTF. Significant differences were noted in the number of convalescent-phase sera that reacted with each virus strain and in the number of seroconversions observed with each test virus strain. Convalescent phase sera that reacted with multiple virus strains often varied significantly in antibody titre from one virus strain to another. This indicates that, in some instances, antibody was probably produced in response to infection by different antigenic variants of CTF virus.

Animals↗
PubMed1990

Nursing ethics and Project 2000.

Project 2000 gives us an opportunity to reconsider the need for nursing ethics in initial nurse education in the United Kingdom. Three arguments are presented to justify its inclusion. The overall aim of an ethics course should be to help the student become an autonomous moral agent, capable of functioning in the complex and difficult nursing environment. Hence, to design such a course we need an analysis of the skills, knowledge and motivation required by such an agent. This will help us choose our objectives and course content. A tentative analysis is offered. Suggestions are made about the teaching of the course and the integration with other subject areas. Some practical, moral and philosophical objections to this approach are considered and replies are offered.

Clinical Competence↗
PubMedDate not supplied

Said another way. Our obligation to float.

TOPIC: Floating is one method that can help alleviate the burden and consequences of the nursing shortage. PURPOSE: The devastating effects that occur as a result of the nursing shortage are discussed. As a result, floating is argued as a viable solution. The practice of floating is explored from an ethical approach. SOURCES OF INFORMATION: Professional literature, electronic resources, nursing textbooks, from statements provided from the American Association of Colleges of Nursing, Joint Commission on Accreditation of Healthcare Organizations, Six Sigma, legal cases, and personal experience. CONCLUSION: Although many nurses oppose the practice of floating, it remains not only necessary, but it is also our obligation. It is acknowledged that floating has its opposition, but the arguments posed are not justifiable when they are weighed against the consequences of not floating.

Attitude of Health Personnel↗