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PubMed1995

The reliability of retrospective studies using a one-year recall period to measure dracunculiasis prevalence in Ghana.

BACKGROUND: Cross-sectional studies are usually adopted to assess the one-year period prevalence of dracunculiasis. They depend upon a recall period of up to one year. This paper aims to examine the degree of accuracy with which villagers in an endemic region recall the occurrence of dracunculiasis during the 12 months prior to a cross-sectional survey. METHODS: Two types of study were conducted in Tolon, a village in Northern Ghana--retrospective and prospective. Data from people interviewed in a bimonthly survey throughout 1990 were compared with the results of a cross-sectional retrospective study conducted in early 1991. RESULTS: The results showed that retrospective studies using a recall period of up to one year to measure dracunculiasis prevalence gave only 59.9% of the actual cases, but there were roughly equal numbers of 'false positive' and 'false negative' cases, so that overall prevalence obtained was very close to the correct figure. CONCLUSIONS: Cross-sectional surveys may be of use to obtain estimates of the one-year period prevalence of dracunculiasis, but are not likely to be reliable enough for more detailed study.

Adult↗
PubMed1997

Reproducibility of retrospective assessment of outdoor time-activity patterns as an individual determinant of long-term ambient ozone exposure.

BACKGROUND: Long-term effects of ambient ozone pollution are not clearly established to date. Epidemiological assessment of these effects might benefit from improved exposure measures. Tools to retrospectively assess long-term time-activity patterns as a potentially important co-predictor of true exposure have not yet been developed. METHODS: Three self-completed questionnaires for the retrospective assessment of outdoor time-activity patterns were tested in 168 lifelong residents (ages 17-21) of California. A test-retest design (within 5-7 days) was employed. (1) Based on a set of questions (AQUES) on outdoor 'heavy' and 'moderate' activity, h/day engaged in activity were derived. Definition of activity levels was based on published data regarding energy expenditure of physical activities. (2) A table format (ATAB) asked quantitative questions for each activity engaged in. (3) A 24-hour-log (A24H) had to be completed to indicate time spent outdoors in four levels of activity (heavy, moderate, light, at rest) on a 'typical day' (n = 44). Test-retest reliability was assessed. Comparison across approaches was restricted to the subgroup of 44 students that completed all three approaches. RESULTS: All approaches yielded reasonably reliable results (between-test variance 13-39% of total variance, Spearman rank correlations: 0.68-0.86 for time spent in outdoor activities). Population mean values differed across approaches, ranging from 1.0 (ATAB) to an unrealistically high estimate of 3.5 (A24H) h/day. The ATAB mean values were close to expectations when compared to published data. CONCLUSIONS: The structure of ATAB has major advantages and mean results were the most valid estimates compared to California population data. The AQUES is a less transparent 'black box' measure of exposure. For long-term retrospective time-activity assessment, we propose to use ATAB. For shorter recall periods the easier AQUES may be a reasonable alternative, yielding similar results as ATAB. The A24H was of limited value.

Adolescent↗
PubMed1996

Evaluating the appropriateness of red blood cell transfusions: the limitations of retrospective medical record reviews.

OBJECTIVE: Several studies have looked at the appropriateness of red blood cell transfusions, using retrospective chart reviews to assess compliance with guidelines. The goal of this study was to determine the quality of medical chart documentation, and assess the validity and the feasibility of using retrospective chart review data as part of a quality improvement (QI) program, to evaluate the appropriateness of peri-operative transfusions. DESIGN: The charts of 188 patients admitted for elective orthopedic surgery were reviewed. Both intra-operative and post-operative transfusion events (n = 353) were analyzed. RESULTS: Only 68% of post-operative transfusion events on the day of surgery and 35% of transfusion events on days after surgery were accompanied by documentation of blood loss and/or change in vital signs. Symptoms were recorded in only 10% of post-operative transfusion events. The rationale for transfusion was recorded in only 16% of post-operative transfusion events on the day of surgery, in 27% on post-operative days and in 95% of intra-operative transfusions. The documentation of rationale was not different for transfusion events involving autologous blood (31%) or allogeneic blood (32%). This study provided information on transfusion practices. Single unit transfusions occurred in only 47 and 34% of patients receiving autologous and allogeneic blood, respectively. Only 19% of patients transfused with more than one allogeneic blood units, were clinically reassessed between blood units, compared to 34% of patients receiving more than one autologous blood unit. We conclude that retrospective chart reviews are limited by inadequate documentation and may not be the optimal source of information to determine the appropriateness of a transfusion. Improved methods (e.g. prospective reviews, or other system-level data collection methods) are needed for QI programs to influence practice. Despite its limitations, the information obtained suggests that current practice could be improved.

Adult↗
PubMed1997

Hospital outcomes research in Germany: results from a retrospective survey among sickness fund beneficiaries.

OBJECTIVES: The authors assess the feasibility of using retrospective, indication-specific patient surveys to conduct hospital outcomes research in Germany. Surgical outcome and patient satisfaction were examined in patients who underwent common elective surgical procedures. METHODS: Using the International Classification of Diseases Ninth Revision coding available in the Schwäbisch Gmünd health insurance data base, all patients for a defined period of time with one of the three following diagnoses were selected and questioned retrospectively using an indication-specific survey instrument: (1) varicose veins of the lower extremity; (2) nasal septum deviation; and (3) inner knee joint damage limited to patients undergoing arthroscopic meniscus repair. Survey content focused on preoperative conditions, pre- and postoperative symptoms, postoperative complications, the nature and duration of postoperative follow-up, and satisfaction with surgical outcome. RESULTS: Significant postoperative improvement of preoperative symptoms was found for all three groups. Complete freedom from symptoms was found in 29.7% of patients treated for varicose veins, 24.1% of patients with meniscus repair, and in only 10.6% of patients with nasal septum deviation. Multivariate analyses indicated that postoperative impairment was the decisive variable governing patient satisfaction for all three groups. CONCLUSIONS: The use of retrospective, indication-specific patient surveys constitutes a time-efficient, cost-effective, and patient-focused option for the systematic acquisition and evaluation of health outcomes in Germany. This methodology holds promise for international and domestic efforts to demonstrate the consequences of restructuring activities in the inpatient sector.

Adult↗
PubMed1993

The treatment of inclusion body myositis: a retrospective review and a randomized, prospective trial of immunosuppressive therapy.

We have sought to examine the response to immunosuppressive therapeutic intervention in inclusion body myositis (IBM) in a retrospective review of prior responses to therapy and in an open, randomized crossover trial. We collected information on the response to prior therapy on 25 patients, and for prospective therapy on 11 of these patients. All met criteria for a definite idiopathic inflammatory myopathy and had biopsy-proven IBM. Clinical and laboratory results were assessed by interviews of patients and by chart review in the retrospective trial. Manual muscle strength was assessed by a single trained observer; the patients' activities of daily living were assessed by questionnaire; and serum tests of muscle-associated enzymes were measured in the prospective trial. In the retrospective review, prednisone appeared to have been of some, albeit modest, clinical benefit in 10 of 25 (40%) patients. Other therapies, primarily azathioprine and methotrexate, also appeared to have halted the progression of weakness in 8 of 35 trials (23%). In the prospective study, combination therapy of oral azathioprine and methotrexate and a biweekly infusion of high-dose intravenous methotrexate with leucovorin rescue were given for 3 to 6 months in an open, crossover design. Both the oral and the intravenous regimens were clinically effective in some patients. There was clinical improvement in 3 trials, stabilization in 11 trials, and worsening in 5 trials, out of a total of 19 completed (22 intended) trials. The presence of active inflammation at entry into the prospective therapeutic protocol, either directly observed on muscle biopsy or indirectly indicated by serum creatine kinase level, may have been associated with clinical improvement. A complete laboratory response with normalization of creatine kinase and other muscle-associated enzymes did not, however, significantly predict clinical responsiveness in the prospective trial. In this first report, to our knowledge, of a prospective trial of immunosuppressive therapy for this disease, stabilization and even slight improvement of strength and functional abilities appeared to be achieved in some patients. We believe that prednisone and other immunosuppressive therapies were of modest benefit in about half of patients with inclusion body myositis, especially those with some evidence of active inflammation. Stabilization of an otherwise inexorably deteriorating course appears, therefore, to be an attainable goal in some patients with IBM.

Adult↗
PubMed2002

Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review.

OBJECTIVE: The anterior lumbar interbody fusion (ALIF) procedure has become an accepted fusion technique for treating patients with degenerative disorders of the lumbar spine. Many consider laparoscopic ALIF to be the least invasive approach. A modification of the open laparotomy--the "mini-open" approach--is an attractive alternative. In this retrospective review, a comparison of these two ALIF approaches is presented. METHODS: We conducted a retrospective review of 98 patients who underwent ALIF procedures between 1996 and 2001 in which either a mini-open or a laparoscopic approach was used. Patient demographics, intraoperative parameters, length of hospitalization, and technique-related complications associated with the use of these two approaches were compared. The subset of patients who underwent L5-S1 ALIF procedures was analyzed separately. Statistical analysis was conducted with chi2 and Student's paired t tests. RESULTS: Between 1996 and 2001, a total of 98 patients underwent ALIF. A laparoscopic approach was used in 47 of these patients, and the mini-open technique was used in the other 51 patients. Operative preparation and procedure time were longer with the use of a laparoscopic approach, and significantly greater during L5-S1 ALIF procedures (P < 0.05). A marginal but significant increase in length of stay was observed after mini-open ALIF procedures (P < 0.05). The immediate postoperative complication rate was greater after mini-open ALIF procedures, 17.6 versus 4.3% (P < 0.05); however, the rate of retrograde ejaculation was higher in the laparoscopic group, 45 versus 6% (P < 0.05). CONCLUSION: Both the laparoscopic and mini-open techniques are effective approaches to use when performing ALIF procedures. On the basis of the data obtained in this retrospective review, the laparoscopic approach does not seem to have a definitive advantage over the mini-open exposure, particularly in an L5-S1 ALIF procedure. In our opinion, the mini-open approach possesses a number of theoretical advantages; however, the individual surgeon's preference ultimately is likely to be the dictating factor.

Adult↗
PubMed2001

International perspectives on antiretroviral resistance. Clinical utility of resistance testing: retrospective and prospective data supporting use and current recommendations.

Data from retrospective and prospective studies support use of genotypic and phenotypic resistance assays to guide treatment changes when initial or subsequent antiretroviral regimens fail. Several retrospective studies have shown that response to antiretroviral therapy can be predicted based on genotypic analysis of HIV, with baseline genotypic evidence of resistance predicting virologic failure. Other retrospective analyses demonstrated that phenotypic drug sensitivity correlates with increased viral load suppression, particularly when virus remains sensitive to two or three drugs at initiation of the regimen. Furthermore, prospective studies such as VIRADAPT and Genotype-Assisted Antiretroviral Resistance Testing (GART) have substantiated that drug selection based on genotypic assay results yield superior viral suppression compared with empiric treatment assignment. One additional study suggested significant improvement in short-term virologic outcome when phenotypic testing was used to guide treatment selection. Based on these findings, resistance testing is currently recommended for patients with acute HIV infection, those who have failed one or more antiretroviral regimens, and pregnant women. Although these tests move toward becoming a standard of care, several research questions remain: the long-term benefit of resistance testing is not yet certain, the interpretation of specific genotypic resistance patterns needs to be better defined, and clinical cut-off points for phenotypic resistance need to be established. As these issues continue to be studied, resistance testing likely will prove a reliable tool to help plan successful ART strategies.

Anti-HIV Agents↗
PubMed1989

The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status.

This research examined the relationship between a measure of health status (defined as the health index--the difference between actual and appraised ages) derived from a health risk appraisal and retrospective health insurance claims taken from one cooperating work organization. A model was defined consisting of 3-year retrospective medical claims as the criterion and age and the health index as predictors. Using a cube-root transformation of medical claims, a significant inverse relationship for age and the health index was identified for men. No relationships were found for women. It was concluded that, for men when age is held constant, a negative relationship exists between retrospective medical claims and a health risk appraisal-generated health status indicator, the health index.

Adult↗
PubMed2003

Retrospective study of the treatment of urethral cancer.

Urethral cancer is rare, encompassing less than 1% of all malignancies. Optimal management, at present, often relies on the limited experience gained from the study of retrospective cases. Therefore, it is imperative to share all available information regarding urethral cancer treatment via reportage of pertinent cases, thus enabling more complete comprehension and decision-making options by both clinicians and researchers. A retrospective review of 18 consecutive patients with primary urethral cancer was performed. An analysis was performed of clinical stage, treatment modality, and outcome. Overall patient survival rate for this retrospective was 44%, with a mean follow-up of 63.5 months. Seven of 10 patients with low-stage diagnosis remained disease free. Comparatively, only one of eight patients with high-stage cancer had no apparent disease. Patients with advanced cancer treated with surgery alone had a shorter disease-free survival (23.3 months) versus those treated with combination chemo/radiation therapy (45.2 months). The major characteristic with prognostic impact was statistically found to be low (T1-2, N0, M0) versus high (T3-4, N1, M1) stage, as assessed by Mann-Whitney U test (z = 2.83, p = 0.0023). Clinical staging afforded the strongest prognostic indication of survival. Patients with low-stage disease exhibited increased survival with single-modality therapy. However, patients with advanced cancer benefited from combined treatment using chemotherapy and radiation therapy.

Adult↗
PubMed2005

Disclosure of diagnostic errors: the death knell of retrospective pathology reviews?

Full disclosure of medical errors to patients is now widely seen as an essential component of error management, although its update into daily clinical practice is variable. Laboratory diagnostic errors are discovered in retrospective reviews of previous surgical and cytopathology cases. This quality assurance practice is a valuable tool of practice audit and change for both cytotechnologists and pathologists. Presently, these diagnostic errors are only reported to the clinician and patient if the new finding affects current patient management. Mandatory full disclosure of all diagnostic errors discovered in the retrospective review process would have a significant adverse impact on cytotechnologists, pathologists, the laboratory, the clinic, the institution, and insurers. Retrospective pathology review would become so burdensome that its survival would be in jeopardy-unless measures are undertaken to ameliorate the anticipated adverse consequences.

Diagnostic Errors↗
PubMed2005

The TREAT Asia HIV Observational Database: baseline and retrospective data.

BACKGROUND: Relatively little is known regarding HIV disease natural history and response to antiretroviral treatments among Asian people infected with HIV. The Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) is a recently established collaborative observational cohort study that aims to assess HIV disease natural history in treated and untreated patients in the Asia-Pacific region. METHODS: Observational data are collected on HIV-infected patients from 11 sites in the Asia-Pacific region. Data are centrally aggregated for analyses, with the first baseline and retrospective data transferred in September 2003. Retrospective data were analyzed to assess the response to highly active antiretroviral treatment (HAART) over a 6-month period in terms of changes in CD4 count and proportions of patients achieving an undetectable HIV viral load (<400 copies/mL). RESULTS: By the end of May 2004, 1887 patients had been recruited to the TAHOD. Seventy-two percent of patients were male, with median age 36 years. Seventy-eight percent of patients reported HIV infection through heterosexual contact. Forty-three percent of patients had a previous AIDS diagnosis, of whom 55% had tuberculosis. The mean 6-month CD4 count increase was 115 cells/muL (SD=127) after starting triple-combination therapy. Smaller CD4 count increases were associated with a higher CD4 count before starting treatment, prior treatment with monotherapy or double therapy, and treatment with a HAART regimen containing a nucleoside reverse transcriptase inhibitor (NRTI) and/or protease inhibitor (PI) but without a nonnucleoside reverse transcriptase inhibitor (NNRTI). Five hundred and ninety-eight patients started HAART and had a viral load assessment at 6 months, with 69% attaining an undetectable viral load. Older patients, patients not exposed to HIV through heterosexual contact, and patients treated with HAART containing NRTIs and NNRTIs but without PIs were found to be more likely to achieve an undetectable level. CONCLUSION: Analyses of retrospective data in the TAHOD suggest that the overall response to HAART in Asian populations is similar to that seen in Western countries.

Adolescent↗
PubMed1999

Retrospective intermodality registration techniques for images of the head: surface-based versus volume-based.

The primary objective of this study is to perform a blinded evaluation of two groups of retrospective image registration techniques, using as a gold standard a prospective marker-based registration method, and to compare the performance of one group with the other. These techniques have already been evaluated individually [27]. In this paper, however, we find that by grouping the techniques as volume based or surface based, we can make some interesting conclusions which were not visible in the earlier study. In order to ensure blindness, all retrospective registrations were performed by participants who had no knowledge of the gold-standard results until after their results had been submitted. Image volumes of three modalities: X-ray computed tomography (CT), magnetic resonance (MR), and positron emission tomography (PET) were obtained from patients undergoing neurosurgery at Vanderbilt University Medical Center on whom bone-implanted fiducial markers were mounted. These volumes had all traces of the markers removed and were provided via the Internet to project collaborators outside Vanderbilt, who then performed retrospective registrations on the volumes, calculating transformations from CT to MR and/or from PET to MR. These investigators communicated their transformations, again via the Internet, to Vanderbilt, where the accuracy of each registration was evaluated. In this evaluation, the accuracy is measured at multiple volumes of interest (VOI's). Our results indicate that the volume-based techniques in this study tended to give substantially more accurate and reliable results than the surface-based ones for the CT-to-MR registration tasks, and slightly more accurate results for the PET-to-MR tasks. Analysis of these results revealed that the rotational component of error was more pronounced for the surface-based group. It was also apparent that all of the registration techniques we examined have the potential to produce satisfactory results much of the time, but that visual inspection is necessary to guard against large errors.

Algorithms↗
PubMed1988

Remembering your parents: reflections on the retrospective method.

In the present paper, I critique the use of the retrospective method when it is used as a proxy for actual longitudinal data on personality development. Studies on the constructive nature of memory cast strong doubts about the meaning of retrospective data. There are good reasons, both theoretical and empirical, to distrust the accuracy of such recall concerning parenting, whether recalled by parents, children, or siblings. Instead of using the method as a shortcut to developmental data, studies examining individual differences in accuracy and distortion and the factors that moderate them may inform us of the various meanings of retrospective data.

Humans↗
PubMed1992

Prospective versus retrospective methods of identifying patients with delirium.

OBJECTIVE: To determine if DSM-III criteria or clinical or discharge diagnoses, reviewed retrospectively, are as accurate an indicator of the presence of delirium as prospective evaluation by a psychiatrist. DESIGN: Selection of delirious patients prospectively by a psychiatrist, followed by retrospective record review of the same patients. SETTING: A referral-based university hospital. PATIENTS: From a sample of 235 consecutive medical patients over age 70, 47 delirious patients were identified prospectively by a research psychiatrist using DSM-III criteria. The medical record of these delirious patients was reviewed after discharge for evidence of delirium. RESULTS: Four patients were assigned ICD-9 codes suggestive of delirium (sensitivity 0.09). Review of physicians' diagnoses correctly identified 8 of 47 (sensitivity 0.17) patients as being delirious or acutely confused. The specific diagnostic criteria necessary to meet a DSM-III diagnosis of delirium could be ascertained from 10 of 47 records (sensitivity 0.21). CONCLUSION: The retrospective medical record review is very imprecise in establishing the diagnosis of delirium. As research in this field moves from descriptive epidemiology to studies of pathogenesis and treatment, prospective designs will be needed.

Abstracting and Indexing↗
PubMed2005

Comparison between prospective and retrospective evaluation of Crohn's disease activity index.

The Crohn's disease activity index (CDAI) is the most widely used measure of clinical disease activity in patients entered into clinical trials. The prospective nature of the CDAI calculation precludes its use as a clinical assessment tool. We compared the retrospective evaluation of the CDAI with the prospective evaluation in a heterogeneous patient population of 100 patients with Crohn's disease. The correlation between the two assessment methods was good with an r-value of 0.84 (p < 0,0001). There was a tendency of patients with a high retrospective CDAI to have a lower prospective CDAI which is explained by intention to treat. This study shows that a retrospective assisted evaluation of the CDAI is as accurate as the traditional prospective evaluation.

Abdominal Pain↗
PubMed1994

Reconstructing selves: an analysis of discrepancies between women's contemporaneous and retrospective accounts of the transition to motherhood.

This paper empirically examines the notion of self-reconstruction. Accounts of personal identity were obtained from women at four time points during the transition to motherhood. The study compares the women's accounts of pregnancy recorded in real-time with those obtained retrospectively--after the child's birth, and looks for discrepancies between them. The women's retrospective records of pregnancy point to a number of reconstructive narratives: glossing over difficulties, emphasizing personal growth, highlighting continuity of self, sometimes combining different narratives within the same retrospective report. The findings are theorized in terms of the notion of self-reconstruction, whereby it is argued individuals modify their biographical presentations in order to produce self-enhancing personal accounts. It is suggested that cognitive, motivational and rhetorical factors all play a part in this process.

Adult↗
PubMed2001

Requests for electroencephalography in a district general hospital: retrospective and prospective audit.

OBJECTIVES: To determine the number of inappropriate requests for electroencephalography (EEG) and whether guidelines on use could reduce this number. DESIGN: Audit with retrospective and prospective components. SETTING: EEG department in district general hospital and centre for neurology and neurosurgery. PARTICIPANTS: Retrospective: 368 at the general hospital and 143 patients at the neurology centre. Prospective: 241 patients undergoing EEG at the general hospital. INTERVENTIONS: Guidelines for EEG issued to users of service at the general hospital. OUTCOMES: Retrospective: differences in requesting practice, result in different clinical scenarios, relative roles of procedure, clinical acumen in establishing diagnosis, usefulness of procedure. Prospective: change of requesting practice, impact on use. RESULTS: There were considerable differences in requesting practice. Non-specialists seem to use EEG as a diagnostic tool, especially in patients with "funny turns," when it is much more likely to yield potentially misleading than clinically useful information. The overall proportion of procedures considered to influence management, to be justifiable, and to be inappropriate were 16% (59), 28.3% (104), and 55.7% (205), respectively. In the prospective study the total number of requests was significantly reduced (chi(2)=33.85, df=5, P<0.0001), mainly because of fewer requests in patients with non-specific "funny turns" (chi(2)=21.90, df=6, P=0.0013). There was a concomitant change in the usefulness of EEG (chi(2 )=26.99, df=2, P<0.0001). CONCLUSIONS: This original audit informed clinical practice and had potential benefits for patients, clinicians, and provision of service. Systematic replication of this project, possibly on a regional basis, could result in financial savings, which would allow development of accessible local neurophysiology services.

Electroencephalography↗
PubMed2003

Consent for clinical research in the neonatal intensive care unit: a retrospective survey and a prospective study.

BACKGROUND: Recruitment into research studies in the neonatal intensive care unit has been problematic. Therefore suggestions have been made to take decision making about enrollment out of the hands of the parents. OBJECTIVE: To understand parental perceptions of the process of recruitment and enrollment for research in the neonatal intensive care unit. METHOD: A questionnaire was developed and used in both a retrospective survey and a prospective study of parents whose newborns were enrolled in trials in a neonatal intensive care unit. Closed ended and open ended questions were included, as well as demographic questions. RESULTS: The retrospective survey had a 79% response rate (29 of 38). Overall, 90% of parents felt that they had made informed decisions, and 93% were against the option that a doctor decide if the newborn should be enrolled into a study, rather than the parent. Although some parents (38%) found that recruitment did add "stress to an already stressful situation", 90% felt that they had made informed decisions and understood the elements of the study. Most parents had been requested to enroll their newborn into more than one trial, and, on average, they thought that they would be comfortable with enrollment into two studies (range 0-6). When asked how the process could be improved, parents suggested that information be made available before delivery. The responses of parents in the prospective study were mostly consistent with those from the retrospective survey. CONCLUSIONS: Overall the parents did not support the suggestion that decision making about enrollment be taken away from parents and put into the hands of doctors. The healthcare team should support parents in their role of decision maker, enhance availability of the research staff, and provide more information about the research.

Attitude↗