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PubMed2006

Paper versus computer: feasibility of an electronic medical record in general pediatrics.

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.

Documentation↗

PubMed1990

EuroQol--a new facility for the measurement of health-related quality of life.

In the course of developing a standardised, non-disease-specific instrument for describing and valuing health states (based on the items in Table 1), the EuroQol Group (whose members are listed in the Appendix) conducted postal surveys in England, The Netherlands and Sweden which indicate a striking similarity in the relative valuations attached to 14 different health states. The data were collected using a visual analogue scale similar to a thermometer. The EuroQol instrument is intended to complement other quality-of-life measures and to facilitate the collection of a common data set for reference purposes. Others interested in participating in the extension of this work are invited to contact the EuroQol Group.

England↗

PubMed1984

VisiCalc and VisiPlot software routines and the analysis of data routinely encountered in steroid biochemistry.

The use of VisiCalc and VisiPlot software routines for performing calculations and graphing of data commonly encountered in steroid biochemistry is described. These software routines have utility and are relatively easy to use, requiring little or no programming experience. Use of these routines is demonstrated in terms of data processing associated with chromatography of receptor preparations and equilibrium binding analyses. The execution of these software routines is rapid and can result in a considerable savings of time and personnel. These and other generically similar software routines should have the greatest utility in laboratories where the experimental design is subject to on-going change.

Animals↗

PubMed1987

Confirmatory factor analysis of house office candidate appraisals.

This article illustrates an application of confirmatory factor analysis, using the LISREL program, to retrospective analysis of rating data common in health professions education. We begin with specification of a causal model reflecting the multitrait-multimethod design of a surgical house-officer ranking system. The model is then tested using data provided by rating system functioning over two successive years. The results suggest that although most rating measures do cluster around latent traits as hypothesized, there is more method variance in the data set than trait variance. The trait and method factors are also found to be highly intercorrelated. Practical implications of these results include specific modifications in the rating system, potentially leading to improvement of the system.

Factor Analysis, Statistical↗

PubMed1992

Application of an essential data set based computer system in support of maternal and child care.

A simple functional application software has been developed to support care providers in information management related to perinatal care activities, family planning encounters and the immunization of infants. This was distributed to some sites and was implemented with no organizational change, though the methods differed. An early assessment of the software after a period of implementation is made based on the observations and experiences reported. This is presented in a framework outlined earlier as the OUST model. The systems objective to enhance the value of information was observed to have been partially achieved. The utility to the users is observed in the ability of the end-users at the sites to identify the local community needs and adopt accordingly suitable strategies. The social impact was seen in the assistance provided by the sentinel action of the system in tracking dropouts from the immunization programme at a site, thereby ensuring quality in care and also economic benefits. From a technical standpoint, the application software was small yet functional and in it were incorporated features that ensured data quality. The application software was designed to generate a unique identity code to assist in follow-up of the target population. Based on the data entered it compiled reports to meet administrative requirements, reports that gave the care providers feedback and lists to coordinate in the follow-up of the target population. The application software is a common data collection tool that can assist in building a data registry for health outcomes research.

Adult↗

PubMed1999

Methods for analyzing health care utilization and costs.

Important questions about health care are often addressed by studying health care utilization. Utilization data have several characteristics that make them a challenge to analyze. In this paper we discuss sources of information, the statistical properties of utilization data, common analytic methods including the two-part model, and some newly available statistical methods including the generalized linear model. We also address issues of study design and new methods for dealing with censored data. Examples are presented.

Data Interpretation, Statistical↗

PubMed2001

Systemic adverse effects of ophthalmic beta-blockers.

OBJECTIVE: To review published clinical information on the systemic adverse effects of ophthalmic beta-blockers for the purpose of developing a pilot contraindication/warning system for active prescriptions in the Veterans Affairs dispensing database. DATA SOURCES: Articles were identified by searching MEDLINE (1966-October 2000) and International Pharmaceutical Abstracts (1970-October 2000). STUDY SELECTION AND DATA EXTRACTION: Article relevance was determined by review of titles, abstracts, and key words. DATA SYNTHESIS: The preponderance of the evidence suggests that ophthalmic beta-blockers may be associated with bronchospasm and adverse cardiovascular effects including bradycardia. Depression and other central nervous system effects are reported less commonly. Data are inadequate to suggest that ophthalmic beta-blocker use is routinely associated with adverse metabolic effects. CONCLUSIONS: The strongest level of evidence (grade A1) supports a contraindication for use of ophthalmic beta-blockers for respiratory disease, with a moderate level of evidence (grade B1) for cardiovascular disease. Data are insufficient to support or refute contraindications for other disease states. The search technique and classification scheme described in this article provide a methodology for evaluating, grading, and applying evidence on potential adverse effects of drug therapy.

Adrenergic beta-Antagonists↗

PubMed2005

Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables.

PURPOSE: Accelerometers are recognized as a valid and objective tool to assess free-living physical activity. Despite the widespread use of accelerometers, there is no standardized way to process and summarize data from them, which limits our ability to compare results across studies. This paper a) reviews decision rules researchers have used in the past, b) compares the impact of using different decision rules on a common data set, and c) identifies issues to consider for accelerometer data reduction. METHODS: The methods sections of studies published in 2003 and 2004 were reviewed to determine what decision rules previous researchers have used to identify wearing period, minimal wear requirement for a valid day, spurious data, number of days used to calculate the outcome variables, and extract bouts of moderate to vigorous physical activity (MVPA). For this study, four data reduction algorithms that employ different decision rules were used to analyze the same data set. RESULTS: The review showed that among studies that reported their decision rules, much variability was observed. Overall, the analyses suggested that using different algorithms impacted several important outcome variables. The most stringent algorithm yielded significantly lower wearing time, the lowest activity counts per minute and counts per day, and fewer minutes of MVPA per day. An exploratory sensitivity analysis revealed that the most stringent inclusion criterion had an impact on sample size and wearing time, which in turn affected many outcome variables. CONCLUSIONS: These findings suggest that the decision rules employed to process accelerometer data have a significant impact on important outcome variables. Until guidelines are developed, it will remain difficult to compare findings across studies.

Acceleration↗

PubMed1992

Assessment of surgical outcome.

Evaluation of outcome of epilepsy surgery is complex because of several factors. Epilepsy is itself a heterogeneous disorder. Different epilepsy centers encounter different referral mixes of patients. Institutions employ various methods for pre-operative evaluation and widely varying surgical techniques. Clear definitions of surgical success and reliable scales for its measurement are lacking. Few data are acquired prospectively and maintained in a format allowing inter-institutional collation of results. A better representation of surgical outcome could in the future be served by adherence to 4 principles: collection of common data in standard formats; comparison of like, rather than disparate, populations; maintenance of quantitative data in raw form; and measurement of outcome along several dimensions or scales. Psychosocial issues have been underemphasized in most prior analyses of outcome.

Cerebral Cortex↗

PubMedDate not supplied

A method for analyzing the financial viability of a rural provider-based geriatric clinic.

Little is known about the financial impact of rural provider-based geriatric outpatient clinics on their parent hospitals since the implementation of the outpatient prospective payment system. In this study, systems theory was used to develop a methodology for determining the financial viability of one such clinic in a rural hospital using data commonly found in rural hospital financial systems. Formulas were developed to identify the overall financial viability and a case-study model was utilized to test the formulas; however, this hospital did not track a key data element, resulting in an incomplete analysis.

Aged↗

PubMed1976

A data structure model for a health information system.

The Ministry of Health and Environmental Control of Berlin is developing a Health Information System (HIS) on the basis of a multi-satellite network system, comprising a central, regional, local and functional unit level. The main part of this paper describes the conceptual structure of the Common Data Base (CDB) of HIS with special regard to the patient-oriented medical information originating from the various institutions of the health care system. This structure comprises the following five levels: 1. PATIENT 2. PROBLEM 3. CASE 4. EVENT 5. ACT Each of the levels represents a node in the structure model. A node is an entity with a set of "local properties" being specified for each level, referring to selected data on inferior levels. The structures of these five levels are described in detail. In the last part, so-called "data-manipulation procedures" are treated. These are descriptions covering any data manipulation and represent the basis of data integrity through system controlled transaction with the data base.

Berlin↗

PubMed1982

Estimating the covariates of childhood mortality from retrospective reports of mothers.

In this paper we compare various models for estimating the covariates of childhood mortality from the type of data commonly available in developing countries. Specifically, we examine how much precision is lost as various pieces of information, such as dates of birth and death for each child, are discarded. The conclusion which we reach is that even incomplete mortality data of the type collected in household surveys or censuses can yield estimates which are very close to those based on the much richer wealth of data collected in detailed maternity histories. Two substantive conclusions of interest are that in the two countries (Sri Lanka and Korea) we examined, the education of the father has a significant and pronounced effect on childhood mortality even when the mother's education is controlled, and once other covariates are controlled, there is no difference between urban and rural childhood mortality.

Age Factors↗

PubMed2001

Better use of data to define nutrition priority and action.

Nutrition and dietary survey data has been useful in defining the magnitude of malnutrition and dietary deficit. Such information has been helpful in gaining attention to support or to do more to improve nutrition-advocacy. However, there are also greater opportunities to use the common data to guide the program action. In summary, we have plenty of good nutrition and dietary information available to us in the planning and operation of nutrition intervention program. If we go beyond the use of data to justify area or subject of engagement, we can also use the same data for more efficient and more effective program without additional cost to us.

Data Collection↗

PubMed2002

Construction of measures from many-facet data.

An extension to the Rasch model for fundamental measurement is described in which there is parameterization not only for examinee ability and item difficulty but also for judge severity. Variants of this model are discussed and judging plans reviewed. Its use and characteristics are explained by an application of the model to an empirical testing situation. A comparison with Generalizability Theory using a common data set is presented as a contrast in approaches to resolving judge indeterminacy.

Calibration↗

PubMed2003

Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.

CONTEXT: Establishing relative benefit or harm from specific antihypertensive agents is limited by the complex array of studies that compare treatments. Network meta-analysis combines direct and indirect evidence to better define risk or benefit. OBJECTIVE: To summarize the available clinical trial evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major cardiovascular disease end points and all-cause mortality. DATA SOURCES AND STUDY SELECTION: We used previous meta-analyses, MEDLINE searches, and journal reviews from January 1995 through December 2002. We identified long-term randomized controlled trials that assessed major cardiovascular disease end points as an outcome. Eligible studies included both those with placebo-treated or untreated controls and those with actively treated controls. DATA EXTRACTION: Network meta-analysis was used to combine direct within-trial between-drug comparisons with indirect evidence from the other trials. The indirect comparisons, which preserve the within-trial randomized findings, were constructed from trials that had one treatment in common. DATA SYNTHESIS: Data were combined from 42 clinical trials that included 192 478 patients randomized to 7 major treatment strategies, including placebo. For all outcomes, low-dose diuretics were superior to placebo: coronary heart disease (CHD; RR, 0.79; 95% confidence interval [CI], 0.69-0.92); congestive heart failure (CHF; RR, 0.51; 95% CI, 0.42-0.62); stroke (RR, 0.71; 0.63-0.81); cardiovascular disease events (RR, 0.76; 95% CI, 0.69-0.83); cardiovascular disease mortality (RR, 0.81; 95% CI, 0.73-0.92); and total mortality (RR, 0.90; 95% CI, 0.84-0.96). None of the first-line treatment strategies-beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, and angiotensin receptor blockers-was significantly better than low-dose diuretics for any outcome. Compared with CCBs, low-dose diuretics were associated with reduced risks of cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00) and CHF (RR, 0.74; 95% CI, 0.67-0.81). Compared with ACE inhibitors, low-dose diuretics were associated with reduced risks of CHF (RR, 0.88; 95% CI, 0.80-0.96), cardiovascular disease events (RR, 0.94; 95% CI, 0.89-1.00), and stroke (RR, 0.86; 0.77-0.97). Compared with beta-blockers, low-dose diuretics were associated with a reduced risk of cardiovascular disease events (RR, 0.89; 95% CI, 0.80-0.98). Compared with alpha-blockers, low-dose diuretics were associated with reduced risks of CHF (RR, 0.51; 95% CI, 0.43-0.60) and cardiovascular disease events (RR, 0.84; 95% CI, 0.75-0.93). Blood pressure changes were similar between comparison treatments. CONCLUSIONS: Low-dose diuretics are the most effective first-line treatment for preventing the occurrence of cardiovascular disease morbidity and mortality. Clinical practice and treatment guidelines should reflect this evidence, and future trials should use low-dose diuretics as the standard for clinically useful comparisons.

Humans↗

PubMed2002

Reliability of birth certificate data: a multi-hospital comparison to medical records information.

OBJECTIVE: To examine the reliability of birth certificate data and determine if reliability differs between teaching and nonteaching hospitals. METHODS: We compared information from birth certificates and medical records in 33,616 women admitted for labor and delivery in 1993-95 to 20 hospitals in Northeast Ohio. Analyses determined the agreement for 36 common data elements, and the sensitivity, specificity, and positive and negative predictive values of birth certificate data, using medical record data as a "gold standard." RESULTS: Sensitivity and positive predictive value varied widely (9-100% and 2-100%, respectively), as did agreement, which was "almost perfect" for measures of prior obstetrical history, delivery type, and infant Apgar score (K = 0.854-0.969) and "substantial" for several other variables (e.g., tobacco use (K = 0.766), gestational age (K = 0.726), prenatal care (K = 0.671)). However, agreement was only "slight" to "moderate" for most maternal risk factors and comorbidities (K = 0.085-0.545) and for several complications of pregnancy and/or labor and delivery (K = 0.285-0.734). Overall agreement was similar in teaching (mean K = 0.51) and nonteaching (K = 0.52) hospitals. Although agreement in teaching and nonteaching hospitals varied for some variables, no systematic differences were seen across types of variables. CONCLUSIONS: Our findings indicate that the reliability of birth certificate data vary for specific elements. Researchers and health policymakers need to be cognizant of the potential limitations of specific data elements.

Birth Certificates↗

PubMed1985

Networking of microcomputers in the radiology department.

A microcomputer may be installed in any of several areas in a radiology department or office to automate data processing. Such areas include the reception desk, the transcription office, the quality-control station, and remote or satellite radiography rooms. Independent microcomputers can be interconnected by networking, using small hardware and software packages and cables, to effect communication between them, afford access to a common data base, and share peripheral devices such as hard disks and printers. A network of microcomputers can perform many of the functions of a larger minicomputer system at lower cost and can be assembled in small modules as budgetary constraints allow.

Computers↗

PubMed2003

Estimation of effects of dioxins and dioxin-like PCBs on wildlife population--a case study on common cormorant.

We presented a method for quantitatively evaluating the effects of chemical pollutants in the environment on a wildlife population. We expressed the effects of exposure to dioxins and dioxin-like PCBs in Tokyo Bay sediment on a common cormorant (Phalacrocorax carbo) population in two ways. One was the changes in the intrinsic growth rate, and the other was the changes in the gross population size. The effects of exposure to the compounds were estimated by using the method of population ecology and available field data. Common cormorant population at Shinobazu Pond in Tokyo, Japan during 1974-1986 was selected as the target population. Intrinsic growth rate or gross size of the population based on the calculated residual level of dioxins and dioxin-like PCBs in the period was estimated to decrease to 89% or 85% of that without exposure to the compounds, respectively.

Animals↗