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Despite their potential utility, clinicians are skeptical about claims data as a substrate for clinical research. Clinician's concerns are centered on two issues-the quality of the data and the fairness of comparisons that are made. To increase the impact of claims data research on clinical practice, several strategies should be pursued.
BACKGROUND: Medication measurement is crucial in assessing quality for chronic conditions yet agreement of alternate data sources remains uncertain. OBJECTIVES: To evaluate medication agreement between interviews, medical records, and pharmacy data; to assess data source contribution to attributing medication exposure; and to describe the impact of combining data sources on models that predict medication use. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Probability sample of HIV-infected participants in the HIV Cost and Services Utilization Study. MEASURES: Medications reported in 2267 interviews, 1936 medical records, and 457 pharmacy records were compared using crude agreement, kappa, and the proportion of average positive and negative agreement. The percent of medications reported in each source alone was used to assess their relative contribution to attributing exposure status. We performed weighted logistic regression in alternate data sources. RESULTS: Kappa varied from 0.38 for nucleoside reverse transcriptase inhibitors to 0.70 for protease inhibitors, when comparing drug classes in interview versus medical record, interview versus pharmacy data, and medical record versus pharmacy data. The percentage of medications reported in medical records was greater than that reported in interviews or pharmacy data. Pharmacy data contributed little to the attribution of medication exposure. Adding medication data to interview data did not appreciably change analytic models predicting medication use. CONCLUSIONS: For specific medications, agreement between alternative data sources is fair to substantial, but is lower for key drug classes. Relying on one data source may lead to misclassification of drug exposure status, but combining data sources does not change the results of analytic models predicting appropriate medication use.
Gonorrhoea and syphilis that belong to our oldest recognized sexually transmitted diseases (STD) are also the prototypes of curable STDs. After the discovery of the causative organisms, Neisseria gonorrhoeae in 1879 and Treponema pallidum in 1905, diagnostic tests were developed and by this, in conjunction with instituted regulations and legislation, means were created for public health authorities to collect statistical data. Sweden has fairly reliable statistics of both syphilis and gonorrhoea from 1912 and onwards, and these data show many interesting characteristics. Syphilis was prevalent in Sweden among both males and females during World War (WW) I and peaked in 1920 with an incidence rate of 150 and 75 per 100,000 population, respectively. The incidence figures fell rapidly after 1920 and reached a low of less than 30 cases per 100,000 in the mid 1920s, probably as a result of systemic treatment with Salvarsan in conjunction with vigorous contact tracing, two important measures to bring an infectious disease under epidemiological control. There was a slight increase of male syphilis in the late 1920s and early 1930s, and of both male and female cases during WW II which never reached the incidence figures of WW I. Penicillin was introduced in the mid 1940s for treatment and was proved superior to Salvarsan. The incidence figures have been very low ever since the early 1950s.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Implementation of electronic medical record systems promises significant advances in patient care, because such systems enhance readability, availability, and data quality. Structured data entry (SDE) applications can prompt for completeness, provide greater accuracy and better ordering for searching and retrieval, and permit validity checks for data quality monitoring, research, and especially decision support. A generic SDE application (OpenSDE) to support documentation of patient history and physical examination findings was developed and tailored for the domain of general pediatrics. OBJECTIVE: To evaluate OpenSDE for its completeness, uniformity of reporting, and usability in general pediatrics. METHODS: Four (trainee) pediatricians documented data for 8 first-visit patients in the traditional, paper-based, medical record and immediately thereafter in OpenSDE (electronic record). The 32 paper records obtained served as the common data source for data entry in OpenSDE by the other 3 physicians (transcribed record). Data entered by 2 experienced users, with all patient information present in the paper record, served as the control record. Data entry times were recorded, and a questionnaire was used to assess users' experiences with OpenSDE. RESULTS: Clinicians documented 44% of all available patient information identically in the paper and electronic records. Twenty-five percent of all patient information was documented only in the paper record, and 31% was present only in the electronic record. Differences were found in patient history and physical examination documentation in the electronic record; more information was missing for patient history (38%) than for physical examination (15%). Furthermore, physical examination contained more additional information (39%) than did patient history (21%). The interobserver agreement of documentation of patient information from the same data source was fair to moderate, with kappa values of 0.39 for patient history and 0.40 for physical examination. Data entry times in OpenSDE decreased from 25 minutes to <15 minutes, indicating a learning effect. The questionnaire revealed a positive attitude toward the use of OpenSDE in daily practice. CONCLUSION: OpenSDE seems to be a promising application for the support of physician data entry in general pediatrics.
Although the prevalence of overweight and obesity among US children is a concern for many health care professionals, incidence rates over time seem to be variable, depending on the assessment measurements used. It is difficult to determine the associated health implications of pediatric obesity or overweight, especially the type that might result in adult obesity or overweight. This review examines the various factors that contribute to the weight and fitness status of children, including anthropometric factors, nutrient intake, the level of physical activity, and nutrition knowledge. Nutrient intake data of the past decade show that the energy and fat intakes of children in the United States have been fairly constant. However, data also indicate that their physical activity has declined. The data strongly suggest that the apparent prevalence of pediatric overweight may not be so much a function of nutrient intake as of a decrease in physical activity leading to an imbalance of energy input and output.
OBJECTIVE: To evaluate the level of evidence regarding the safety of outpatient pediatric tonsillectomy. STUDY DESIGN AND SETTING: The medical literature addressing outpatient pediatric tonsillectomy was systematically reviewed. The level of evidence was assessed, and data were pooled. RESULTS: Seventeen articles met inclusion criteria. Each article suggested that outpatient tonsillectomy was safe. The overall level of evidence was fair (grade B-). Pooled data analysis in the perioperative period showed a complication rate estimate of 8.8% (95% confidence interval [CI], 5.5%-12.1%; P < or = 0.001) and an unplanned admission rate estimate of 8.0% (95% CI, 5.3%-10.7%; P < or = 0.001). Subgroup analysis suggests that children under age 4 are at a higher risk of complications in the perioperative period with an odds ratio of 1.64 (95% CI, 1.16-2.31). CONCLUSION: The level of evidence supporting the safety of outpatient pediatric tonsillectomy is fair. The analyzed data show a higher rate of early complications and unplanned admissions in children under age 4. SIGNIFICANCE: The current evidence supports the practice of outpatient tonsillectomy in properly selected children. EBM RATING: A-1a.
We consider data clustering problems where partial grouping is known a priori. We formulate such biased grouping problems as a constrained optimization problem, where structural properties of the data define the goodness of a grouping and partial grouping cues define the feasibility of a grouping. We enforce grouping smoothness and fairness on labeled data points so that sparse partial grouping information can be effectively propagated to the unlabeled data. Considering the normalized cuts criterion in particular, our formulation leads to a constrained eigenvalue problem. By generalizing the Rayleigh-Ritz theorem to projected matrices, we find the global optimum in the relaxed continuous domain by eigendecomposition, from which a near-global optimum to the discrete labeling problem can be obtained effectively. We apply our method to real image segmentation problems, where partial grouping priors can often be derived based on a crude spatial attentional map that binds places with common salient features or focuses on expected object locations. We demonstrate not only that it is possible to integrate both image structures and priors in a single grouping process, but also that objects can be segregated from the background without specific object knowledge.
Single-photon emission tomography (SPET), using technetium-99m hexamethylpropylene amine oxime, and positron emission tomography (PET), using oxygen-15 butanol were compared in six healthy male volunteers with regard to the mapping of resting state regional cerebral blood flow (rCBF). A computerized brain atlas was utilized for 3D regional analyses and comparison of 64 selected and normalized volumes of interest (VOIs). The normalized mean rCBF values in SPET, as compared to PET, were higher in most of the Brodmann areas in the frontal and parietal lobes (4.8% and 8.7% respectively). The average differences were small in the temporal (2. 3%) and occipital (1.1%) lobes. PET values were clearly higher in small VOIs like the thalamus (12.3%), hippocampus (12.3%) and basal ganglia (9.9%). A resolution phantom study showed that the in-plane SPET/PET system resolution was 11.0/7.5 mm. In conclusion, SPET and PET data demonstrated a fairly good agreement despite the superior spatial resolution of PET. The differences between SPET and PET rCBF are mainly due to physiological and physical factors, the data processing, normalization and co-registration methods. In order to further improve mapping of rCBF with SPET it is imperative not only to improve the spatial resolution but also to apply accurate correction techniques for scatter, attenuation and non-linear extraction.
We estimate the Gibbs free energy for nonspecific binding (DeltaGNSB) to the Escherichia coli DNA for two regulatory proteins of the lambda phage, CI and Cro. By means of a statistical-mechanical approach, we calculate the cI and cro activities associated with the operator OR of an introduced lambda phage genome (prophage). In this statistical model we apply in vitro-measured binding free energies to fit in vivo experimental data for cI and cro activities, respectively, where DeltaGNSB is introduced as a free (fitting) parameter. Without nonspecific binding included in the model, the quality of the description is fairly poor, whereas data are nicely correlating with our model with nonspecific binding included over the entire data range. The obtained values of DeltaGNSB are -4.1+/-0.9 kcal/mol, for CI, and -4.2+/-0.8 kcal/mol, for Cro. In particular, in a lysogen (approximately 250 CI monomers per cell) we conclude that 86% of the total CI in the cell is nonspecifically bound, leaving on average around 10 CI dimers freely available in the E. coli cytoplasma. These findings corroborate the view that due to low free cellular particle numbers a dynamical analysis of genetic regulation at OR and comparable systems should include a stochastic component. In addition, we perform a stability analysis of the OR system in the presence of nonspecific binding.
The method of backcalculation estimates past HIV infection rates from available AIDS incidence data and an estimate of the incubation period. The method is used on the Malaysian data to model the AIDS epidemic because it makes use of the Malaysian AIDS incidence data which is fairly reliable and is more reflective of the trend of the epidemic as compared to the HIV infection rate recorded. An application is made on the monthly AIDS incidence data in Malaysia from January 1995 until August 1996 released by the Ministry of Health, Malaysia using the backcalculation program from Bacchetti et al and the incubation period distribution from Brookmeyer to generate the current HIV infection rate for Malaysia (until August 1996).
OBJECTIVE: To determine the frequency, clinical characteristics and outcome of acute invasive infections caused by Haemophilus influenzae. DESIGN: Prospective hospital-based surveillance. SETTING: Six large academic referral hospitals in India. PARTICIPANTS: Three thousand four hundred forty-one patients from infancy to adulthood with pneumonia, meningitis or suspected bacterial sepsis. RESULTS: Preliminary data from 24 months of surveillance are presented. There were 58 H. influenzae isolates, of which 96% were serotype b. Nearly all isolates were from infants and children <5 years old, and most of the childhood isolates were from infants <1 year of age. Meningitis cases accounted for 69% of isolates. Overall case fatality was 11%. More than 50% of isolates were resistant to chloramphenicol, and up to 40% were resistant to ampicillin, trimethoprim-sulfamethoxazole or erythromycin. There was no resistance to third-generation cephalosporins. CONCLUSIONS: These preliminary data from six hospitals suggest a substantial burden of severe, preventable H. influenzae infections in India. The distribution of clinical syndromes and the ages of our Hib patients are fairly similar to data from North America and Europe.
The applicability of SAR (structure-activity relationship) techniques to data obtained using high throughput screening (HTS) and toxicogenomic techniques is explored. The reason for this study derives from the fact that for economical and time considerations HTS bioassays may consist of single determinations, i.e. lack of duplication. This introduces an element of uncertainty. Using two different data bases of fairly complex biological phenomena (allergic contact dermatitis in humans and the induction of mutations in Salmonella), it is demonstrated that the resulting SAR models can tolerate up to 20% ambiguity in the experimental data.
Perfusion studies based on pulsed arterial spin labeling have primarily applied hyperbolic secant (HS) pulses for spin inversion. To optimize perfusion sensitivity, it is highly desirable to implement the HS pulse with the same slice width as the width of the imaging pulse. Unfortunately, this approach causes interactions between the slice profiles and manifests as residual signal from static tissue in the resultant perfusion image. This problem is currently overcome by increasing the selective HS width relative to the imaging slice width. However, this solution increases the time for the labeled blood to reach the imaging slice (transit time), causing loss of perfusion sensitivity as a result of T(1) relaxation effects. In this study, we demonstrate that the preceding problems can be largely overcome by use of the C-shaped frequency offset corrected inversion (FOCI) pulse [Ordidge et al., Magn Reson Med 1996;36:562]. The implementation of this pulse for multislice perfusion imaging on the cerebrum is presented, showing substantial improvement in slice definition in vivo compared with the HS pulse. The sharper FOCI profile is shown to reduce the physical gap (or "safety margin") between the inversion and imaging slabs, resulting in a significant increase in perfusion signal without residual contamination from static tissue. The mean +/- SE (n = 6) gray matter perfusion-weighted signal (DeltaM/M(o)) without the application of vascular signal suppression gradients were 1.19 +/- 0. 10% (HS-flow-sensitive alternating inversion recovery [FAIR]), and 1. 51 +/- 0.11% for the FOCI-FAIR sequence. The corresponding values with vascular signal suppression were 0.64 +/- 0.14%, and 0.91 +/- 0. 08% using the HS- and FOCI-FAIR sequences, respectively. Compared with the HS-based data, the FOCI-FAIR results correspond to an average increase in perfusion signal of up to between 26%-30%. Magn Reson Med 42:1098-1105, 1999.
OBJECTIVE: To assess the degree of underestimation of nutrient intakes caused by missing data in McCance and Widdowson's food tables and supplements, the standard food tables used in the UK. SUBJECTS: 1026 children aged 18 months. SETTING: A research clinic in Bristol. INTERVENTIONS: A 3-day dietary diary was completed for each child. These were coded and analysed using a database consisting of the unedited information in the food tables, to produce a set of 'uncorrected' nutrient intakes. 'Guesstimated' values for nutrient content were then added to our nutrient database in place of the missing values in the food tables, and the daily nutrient intakes were recalculated. MAIN OUTCOME MEASURES: Calculated daily nutrient intakes before and after substituting missing data in the food tables for guesstimated values. RESULTS: Of the 1027 foods used in the analysis, 540 had missing data for one or more nutrient content. For several of the nutrients examined adding guesstimated values altered the calculated nutrient intake of more than 90% of the subjects. However, for nutrients such as the B vitamins and the major minerals the mean percentage underestimate was very small. We calculated the underestimation of nutrient intake to be largest for vitamins E and D (13.8% and 14.7%, respectively). The effect of missing data on calculated nutrient intakes was proportionately greater at the bottom end of the nutrient intake distribution. CONCLUSION: Missing data has a fairly small effect on calculated mean daily intakes. However, it can result in some individuals being misranked within a nutrient intake distribution. The availability of a standard set of 'guesstimates' to use in place of missing data would reduce this problem, and would improve comparability between dietary surveys.
OBJECTIVE: To assess agreement of injury reporting between primary care medical record and maternal interview. METHODS: Cross-sectional study of data from a randomized controlled trial of home visiting. The setting was Hawaii's Healthy Start Program (HSP). Subjects comprised a population-based sample of children in at-risk families with 3 years of primary care medical records and maternal interviews (n = 443). Outcome measures were percentage of children injured unintentionally and mean number of injuries per child in the first 3 years of life by primary care medical record and maternal interview. RESULTS: We identified 490 injuries: 48% by primary care medical record, 22% by maternal interview, and 30% in both sources. More children were reported injured by primary care medical record than maternal interview (51% vs 39%, P< .001). The mean number of injuries per child was 0.87 by primary care medical record and 0.51 by maternal interview (difference 0.36, 95% confidence interval 0.27-0.45, P< .001). Agreement between data sources was fair (kappa = 0.47). CONCLUSIONS: This study estimates that 25% of childhood injuries may not be reported in the medical record, highlighting the need for reconsideration of the use of medical records as the gold standard for unintentional injury data. Caution should be used when interpreting injury data from one source, especially from families with stressful life situations. Poor communication regarding injuries between social service, primary care and urgent care providers may contribute to decreased quality of primary care and missed opportunities for injury prevention.
BACKGROUND: The International Committee on Taxonomy of Viruses (ICTV) is responsible for developing and maintaining a universal virus taxonomy. As the reference framework for organising the viral world, it is essential for virology and related fields. Despite its widespread use in research and public health, programmatic access to ICTV taxonomy has remained limited, posing challenges for integration, versioning, and interoperability across databases and bioinformatics resources requiring up-to-date virus taxonomy. FINDINGS: To address this, we developed a public and sustainable solution leveraging ontology-based APIs. All available ICTV Master Species List (MSL) releases, from MSL1 to MSL41, were transformed into a unified, semantically structured ontology comprising more than 195,000 current and historical entities and deployed through the Ontology Lookup Service (OLS). The ontology is automatically rebuilt and republished whenever a new MSL release becomes available. Complementary ICTV-NCBI mappings and helper libraries support integration into downstream systems. CONCLUSIONS: Together, these resources enable, for the first time, public programmatic retrieval of current and historical ICTV taxon names, taxonomic relationships, metadata, and persistent identifiers through stable endpoints, including resolution of former taxonomic terms to their current accepted taxon or taxa and retrieval of taxon histories across releases. More broadly, this work illustrates a general strategy for transforming structured biological datasets into semantically enriched graph resources exposed through scalable public APIs. These developments enhance interoperability, reduce manual curation, and support FAIR-aligned taxonomic data management in virology and pandemic preparedness.
The International Committee on Taxonomy of Viruses (ICTV) is responsible for developing and maintaining a universal virus taxonomy. As the reference framework for organising the viral world, it is essential for virology and related fields. Despite its widespread use in research and public health, programmatic access to ICTV taxonomy has remained limited, posing challenges for integration, versioning, and interoperability across databases and bioinformatics resources requiring up-to-date virus taxonomy. To address this, we developed a public and sustainable solution leveraging ontology-based APIs. Successive ICTV Master Species List (MSL) releases were transformed into a structured ontology and deployed as a unified representation through the Ontology Lookup Service (OLS). The framework also provides ICTV-NCBI mappings and helper libraries for integration into downstream systems. This enables, for the first time, public programmatic retrieval of current and historical virological taxon names, taxonomic relationships, metadata, and persistent identifiers through stable endpoints. More broadly, this work illustrates a general strategy for transforming structured biological datasets into semantically enriched graph resources exposed through scalable public APIs. These developments enhance interoperability, reduce manual curation, and support FAIR-aligned taxonomic data management in virology and pandemic preparedness.
Detailed referral information from one practice was used to investigate the effect of calculating referral rates in several different ways. Referral rates for individual general practitioners should be related to the number of consultations carried out and not to the number of registered patients; for whole practices list size may be used as the denominator. Most doctors will not need to control for age and sex of patients when comparing referral rates but may need to control for case mix when comparing referral rates to individual specialties. In addition, a method is described for distinguishing systematic variation between the referral rates of individual doctors from the random variation that may arise from data based on fairly small numbers of referrals. The method indicates whether systematic variation is greater than would be expected by chance, and it can be extended to indicate whether variability in referral rates is greater in one specialty than another. Because of random variation with time a year's data may not be sufficient to allow reliable interpretation of referral rates to individual specialties, except for the largest. At present there is no known relation between high or low referral rates and quality of care. Nevertheless, if doctors are to interpret their own rates of referral they need those rates to be reliable and valid. Use of the 10 guidelines described in this paper will help to prevent unwarranted conclusions being drawn from information on general practitioners' rates of referral to hospital.