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Guidelines for the uniform reporting of data for Medical Emergency Teams.

It is more than 15 years since the first Medical Emergency Team (MET) system was introduced to identify patients at risk and prevent serious adverse events in Liverpool Hospital, Sydney, Australia. Since then the MET system has been introduced to many other hospitals in Australia and around the world. Standardised and complete reporting of data related to MET activity is increasingly important to identify the role and benefits of the system and to facilitate quality improvement in health care in general. A uniform method for reporting data related to MET activity will aid interpretation of results, comparisons, review and changes to the MET system. The guidelines for uniform reporting of data in relation to MET activities used in our group of hospitals are presented. Future refinement and consensus agreement on the reporting of MET data internationally should enable comparisons between MET systems in several countries.

Australia↗

Development and application of software tools for monitoring, assessment and reporting of data concerning the operation of urban wastewater treatment plants in Cyprus.

This work focuses on the development and application of appropriate software tools for recording, assessing and reporting data related to the operation of the Urban Wastewater Treatment Plants (UWTPs) in Cyprus. An appropriate Internet-Based Management System was designed, developed and installed at the premises of the UWTPs and of the Cypriot Competent Authority (Water Development Department - WDD) in order to coordinate and disseminate tasks and related information for monitoring the operation of UWTPs. In addition, a client Geographical Information System database was compiled to be used for obtaining and analyzing spatial information. The software tools are based on common procedures and state-of-the-art technology for the recording and transmission of data and information and they provide an integrated view related to the operation and the efficiency of wastewater treatment systems. Moreover, continuous control and systematic monitoring of the UWTPs by the operators as well as continuous and direct supervision of the UWTPs environmental performance is achieved by the personnel of the Competent Authority. Furthermore, direct and unobstructed provision of data to the Competent Authority of Cyprus is accomplished by the operators of the UWTPs, while the Competent Authority is supported to compose full and representative reports to the European Commission and other International Organizations. The developed tools enable the direct recording of data obtained through measurements and analyses, permit the comparison of data with existing legislation and provide an integrated picture of the operation of the wastewater treatment plants as well as the option to focus and assess each individual treatment stage.

Cities↗

Breast imaging reporting and data system (BI-RADS).

The Breast Imaging Reporting and Data System (BI-RADS) lexicon was developed by the American College of Radiology to standardize mammographic reporting. The BI-RADS lexicon defines terms to describe abnormalities on mammograms, and it defines final assessment categories that are predictive of the likelihood of malignancy. Although the lexicon is clinically useful and facilitates communication and research, there is still substantial interobserver variability in its application. Lexicons for breast sonography and breast MRI are in progress.

Breast Diseases↗

The National Cancer Data Base report on longitudinal observations on prostate cancer.

BACKGROUND: Data on 349,154 prostate cancer cases diagnosed since 1986 have been entered to the American College of Surgeons National Cancer Data Base (NCDB). Previous annual reports have examined subsets of these data. The present report highlights major trends in the presentation and treatment of prostate cancer in the United States evident from longitudinal analyses of the entire data. METHODS: NCDB data are collected following a computerized, standard format. Hospital participation is voluntary. RESULTS: Since the first year of data collection, the number of participating hospitals has increased from 496 to 996 and the number of prostate cancer patients reported to the NCDB increased from 19,531 to 84,408. The proportion of men diagnosed at ages younger than 70 years increased from 37.8% in 1986 to 46.9% in 1993. Completeness of reporting stage of disease and tumor grade has improved. The proportions of both the earliest (American joint Committee an Cancer [AJCC] Stage Groups 0 and I) and the most advanced (AJCC++ Stage Group IV) stages declined. The proportion of Grade 2 (moderately differentiated) tumors increased from 38.6% in 1986 to 57.5% in 1993. The proportion of AJCC Stage II prostate cancer increased from 19% in 1986 to 48.4% in 1993. The proportion of patients treated by prostatectomy increased from 9.9% in 1986 to 29.2% in 1993. The proportion of patients receiving no cancer directed treatment declined from 41.8% in 1986 to 21.6% in 1993. Less change was observed in the use of radiation and hormonal treatments. CONCLUSIONS: These data show that the clinical patterns of prostate cancer have changed markedly in recent years.

Age Factors↗

Clinical evaluation of the effects of signal integrity and saturation on data availability and accuracy of Masimo SE and Nellcor N-395 oximeters in children.

UNLABELLED: Pulse oximetry manufacturers have introduced technologies that claim improved detection of hypoxemic events. Because improvements in signal processing and data rejection algorithms may differentially affect data reporting, we compared the data reporting and signal heuristic performance and agreement among the Nellcor N-395, Masimo SET, and GE Solar 8000 oximeters under a spectrum of conditions of signal integrity and arterial oxygen saturations. A blinded side-by-side comparison of technologies was performed in 27 patients, and data were analyzed for time of data availability, measures of agreement and signal heuristics, and warnings stratified by signal integrity and SpO(2). The Solar 8000 had less total data dropout than either of the new technologies. Masimo's LoSIQ (signal quality) heuristic rejected less data than Nellcor's MOT/PS (motion/pulse search) flag. When no signal heuristic was displayed, there was little difference in precision and bias between the two newer technologies; however, agreement between devices deteriorated in the presence of SIQ, MOT, or hypoxemia. Both newer devices flagged questionable data, but their use of different rejection algorithms resulted in different probabilities of presenting data. Therefore, with poor SIQ or during hypoxemia, the Nellcor N-395 and Masimo oximeters are not clinically equivalent to each other or to the older Solar 8000 oximeter. IMPLICATIONS: We compared new pulse oximeters from Nellcor and Masimo and found that, with good signal conditions, both new devices performed similarly to older technology. Overall, Masimo reported less data as questionable than Nellcor. With poor signal conditions or during hypoxemia, the new devices are not clinically equivalent to each other or to the older technology.

Algorithms↗

Availability of immune globulin intravenous for treatment of immune deficient patients--United States, 1997-1998.

Immune globulin intravenous (IGIV) is a lifesaving treatment for patients with primary immunodeficiency. Since November 1997, a shortage of IGIV has existed in the United States. In 1998, the Food and Drug Administration (FDA) required pharmaceutical companies to increase the frequency of reporting on IGIV distribution from biannually to monthly; in addition, FDA facilitated IGIV distribution and informed clinicians about the ongoing shortage. To assess the impact of the IGIV shortage on patient care, in 1998 the Immune Deficiency Foundation (IDF) surveyed physicians caring for immunodeficient patients about whether they have had difficulty obtaining IGIV, measures they have taken because of the shortage, and the effect of the shortage on their patients. This report summarizes data reported to FDA and data obtained from the IDF survey and provides recommendations for IGIV use during the shortage.

Drug Utilization↗

The National Cancer Data Base. Report on colon cancer.

BACKGROUND: Commission on Cancer data from the National Cancer Data Base (NCDB) report time trends in stage of disease, treatment patterns, and survival for patients with selected cancers. The most current data (1993) for patients with colon cancer are described. METHODS: Five calls for data yielded 3,700,000 cases of cancer for the years 1985 through 1993 from hospital cancer registeries across the U.S., including 36,937 cases of colon cancer from 1988 and 44,812 from 1993. RESULTS: Interesting trends are as follows: (1) the elderly ( > 80 years) present with earlier stage disease than younger patients; (2) the National Cancer Institute recognized cancer centers have more patients with advanced disease than other types of hospitals; (3) all ethnic groups have generally similar stages of disease at presentation, except for African-Americans who have a slightly higher incidence of Stage IV disease; (4) the proximal migration of the primary cancer continues with 54.7% of primary colon cancer arising in the right colon in 1993 compared with 50.9% in 1988; (5) an interaction between grade and stage of cancer seems present; and (6) patients with Stage III colon cancer who received adjuvant chemotherapy had a 5% improvement in 5-year relative survival. CONCLUSIONS: The NCDB data are useful for reporting what cancer treatments are being administered and what outcomes are occurring in the U.S. The data suggest an important biologic role for grade of cancer. They also suggest that African-Americans and other ethnic groups have the same outcome as non-Hispanic whites but that access to medical care may still be less. Finally, the utility of adjuvant therapy for Stage III colon cancer may just be beginning to be appreciated.

Aged↗

Comparison of woman-specific versus breast-specific data for reporting screening mammography performance.

RATIONALE AND OBJECTIVES: Screening mammography data can be reported on a breast-specific or woman-specific level, and much mammography data available for research is woman-specific. The purpose of this study was to determine if woman-specific screening mammography data are sufficient for research and reporting by measuring and comparing the accuracy of screening mammography on a breast-specific and on a woman-specific level. MATERIALS AND METHODS: Definitions for true-positive and false-positive mammography results were developed to distinguish between breast-specific and woman-specific calculations. The sensitivity, specificity, and positive predictive values of screening mammography were calculated on a breast-specific and on a woman-specific basis for the entire population of the Carolina Mammography Registry and for a randomly selected subset of the population. RESULTS: Only small differences were found in breast-specific versus woman-specific calculations of sensitivity, specificity, and positive predictive values for both the entire population and the smaller subset population. For both populations, woman-specific sensitivity and positive predictive values were slightly higher than the same breast-specific values, and woman-specific specificity was slightly lower. CONCLUSION: For research and reporting, woman-specific data are sufficient.

Adult↗

Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups.

Variation in the sociodemographic, system, and disease characteristics of Asians and Pacific Islanders compared with other ethnic groups and the quality of standard self-report measures of health and functioning by ethnic groups were examined. Secondary analysis of self-report data from the Medical Outcomes Study, an observational study of adult outpatients who received care in either prepaid or fee-for-service plans, was used to compare 527 Asians and Pacific Islanders to patients in other ethnic groups (16,989 whites, 2,533 African Americans, 1,009 Latinos, and 446 others). These patients all completed a screening questionnaire after visits with a Medical Outcomes Study clinician. Asians and Pacific Islanders were similar to African Americans and Latinos on most sociodemographic and system characteristics, disease status, and risk factors. Ethnicity was a significant predictor of differences in self-reported health. As a group, Asians and Pacific Islanders had better health or health of equal status compared with whites, but were less satisfied and perceived less sharing in the doctor-patient relationship compared with other ethnic groups. However, results suggest that data from standard functioning measures for Asians should be interpreted with caution and that more work is needed to understand better the social and cultural influences on the health of Asians and Pacific Islanders.

Adolescent↗

Differences in measured and self-reported height and weight in Dutch adolescents.

BACKGROUND/AIMS: Monitoring overweight prevalence and its trends in Dutch youth is frequently based on self-reported data. The validity of self-reported data especially in young adolescents is not sufficiently known. The purpose of this study is to study the validity of self-reported height and weight in 12- to 13-year-olds, to identify sociodemographic correlates and to explore whether correction factors can be developed to estimate the prevalence of overweight in youth. METHODS: 5,525 12- to 13-year-old pupils in the Rotterdam area filled in a confidential questionnaire on health topics, including their height and weight. In a sub-sample of 499 pupils both self-reported and measured height and weight were available. RESULTS: Self-reported data led to a considerable underestimation of Body Mass Index and consequently the prevalence of overweight. Underestimation was higher in pupils who regarded themselves as more fat, were of non-Dutch origin and in lower education levels. CONCLUSION: Self-reported height and weight appeared to be inappropriate to estimate the overweight prevalence in 12- to 13-year-olds, unless the figures were adjusted. Using adjusted self-reported BMI on an individual level is questionable. Actual measurements of height and weight are necessary to draw up valid correction formulas in new samples.

Adolescent↗

International cooperation to collect obstetric data.

Reported are preliminary results of an international collection of data initiated by FIGO. Data of 33.000 deliveries in 19 countries, five countries each in South America, Africa, and Asia and four in Europe provided a good basis for comparison and called attention to shortcomings in each individual country and to the need for more progress in obstetric treatment. - Sociological and demographic items in a questionnaire bring into focus the importance of both family planning and sexual education. - The authors consider this data collection a preliminary study for modernisation of Tauffer Statistics.

Africa↗

Recommendations for uniform reporting of data following major trauma--the Utstein Style: an initiative. International Trauma Anaesthesia and Critical Care Society (ITACCS)

Basic and advanced care of trauma patients always has been an important aspect of prehospital and immediate in-hospital Emergency Medicine, involving a broad spectrum of disciplines, specialties, and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources, and operation. This complex background, at least in part, has hindered the development of a uniform pattern or set of criteria and definitions. This in turn, has rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be evaluated or compared readily with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA, and other International Organisations represented in ILCOR--on Uniform Reporting of Data following Out-of-hospital and In-hospital Cardiac Arrest--the Utstein Style, an international working group of ITACCS, has drafted a document, Recommendations for Uniform Reporting of Data following Major Trauma--the Utstein Style. The reporting system is based on the following considerations: 1) A structured reporting system based on an "Utstein style template" that would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance, and quality of care (and enable groups to challenge performance statistics that did not take account of all relevant information); 2) The Recommendations and Template should encompass both out-of-hospital and in-hospital trauma care; 3) The Recommendations and Template should permit further intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives; and 4) The Template should facilitate studies setting out to improve epidemiological understanding of trauma; for example, such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on "prehospital cardiac arrest". It includes a glossary of terms used in the prehospital and early hospital phase as definitions, time points, and time intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance, and finally, one for the hospital. For clarity, data should be reported as core data (i.e., always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein Template for pre- or in-hospital cardiac arrest, respectively, the present Template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: I. INTRODUCTION AND BACKGROUND: II. TRAUMA DATA STRUCTURE DEVELOPMENT: A general outline of the development of structured data using object-oriented modelling (which will be discussed in due course) and includes a set of explanatory illustrations; III. TERMS AND DEFINITIONS: Outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma, and predominant trauma); IV. FACTORS RELATING TO THE CIRCUMSTANCES OF THE INJURY: Describes the following items: a) Cause of injury e.g., type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc.; b) Severity of Injury--e.g., prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from "1" = head to "9" = external; the physiological disability scale ranges ordinally from "0"; c) Mechanism of injury--recording for transportation incidents etc; e.g., the type of impact, possible restraining devices,

Anesthesiology↗

"Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS).

Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po

Data Collection↗

The influence of psychological and social factors on accuracy of self-reported blood pressure.

The data reported here document levels of accuracy in reports of blood pressure and identify correlates of inaccurate reporting. The data come from a long-term follow-up of a cohort of African-American women who registered for antepartum care between September, 1967 and June, 1969. At the follow-up interview, these women were asked whether they had ever received a diagnosis of hypertension from a physician. The self-reports of hypertension were compared with information contained in the medical records of these women. Twenty-five percent reported having high blood pressure but 53% of these reports were unconfirmed by their medical records (overall misreporting rates was 15.9% with 2.5% underreporting and 13.4% overreporting). The factors related to misreporting included a psychiatric diagnosis (based on the Diagnostic Interview Schedule) of major depressive disorder or drug and/or alcohol abuse and a small social network. The conjunction of these three variables significantly affected accuracy of reporting (100% misreporting with all three variables). These results suggest that, using currently standard methodology, there is an unreliable subpopulation of respondents in health surveys that may require the collection of data on health status from a second source to confirm data from self-reported health measures.

Adult↗

Vaccination coverage among children enrolled in Head Start programs, licensed child care facilities, and entering school--United States, 2000-01 school year.

The implementation of state and local requirements for vaccination before entry to Head Start programs, licensed child care facilities, and school has resulted in high vaccination levels among preschool and school children. One of the national health objectives for 2010 is to maintain > or = 95% vaccination coverage among children attending licensed child care centers and kindergarten through postsecondary school (objective 12-23). National estimates of vaccination coverage among children in Head Start programs, licensed child care facilities, and those entering school have been published each year since 1997 on the basis of reports from federally funded immunization programs (IPs) in the 50 states, five cities, eight territories, and the District of Columbia. This report summarizes data reported by states, cities, and the District of Columbia for the 2000-01 school year. Although vaccination coverage for 2000-01 appears similar to that for previous years, the number of programs reporting and the completeness of the reports are lower than in previous years and do not permit precise estimation of coverage at the national level. IPs use school data to identify undervaccinated children enrolled in Head Start programs, licensed child care facilities, and those entering school; evaluate the success of prevention programs targeting these children; and document the proportion of children whose parents claim exemptions from one or more vaccines. Plans are ongoing to assist IPs in applying successful strategies for collecting, reporting, and increasing the precision of coverage estimates for these populations.

Child↗

Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop.

PURPOSE: To begin a process of standardizing the methods for reporting clinical data in the field of uveitis. DESIGN: Consensus workshop. METHODS: Members of an international working group were surveyed about diagnostic terminology, inflammation grading schema, and outcome measures, and the results used to develop a series of proposals to better standardize the use of these entities. Small groups employed nominal group techniques to achieve consensus on several of these issues. RESULTS: The group affirmed that an anatomic classification of uveitis should be used as a framework for subsequent work on diagnostic criteria for specific uveitic syndromes, and that the classification of uveitis entities should be on the basis of the location of the inflammation and not on the presence of structural complications. Issues regarding the use of the terms "intermediate uveitis," "pars planitis," "panuveitis," and descriptors of the onset and course of the uveitis were addressed. The following were adopted: standardized grading schema for anterior chamber cells, anterior chamber flare, and for vitreous haze; standardized methods of recording structural complications of uveitis; standardized definitions of outcomes, including "inactive" inflammation, "improvement'; and "worsening" of the inflammation, and "corticosteroid sparing," and standardized guidelines for reporting visual acuity outcomes. CONCLUSIONS: A process of standardizing the approach to reporting clinical data in uveitis research has begun, and several terms have been standardized.

Humans↗

The National Cancer Data Base report on patterns of hospital reporting.

BACKGROUND: Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data are described here. METHODS: Five calls for data have yielded a total of 3,700,000 cases for the years 1985 through 1993, including 477,679 cases for 1988, and 608,593 cases for 1993, from hospital cancer registries across the U.S. RESULTS: The most recent call for data for 1993 comprised 52% of the estimated new cases of cancer in the U.S. The country was comprised of 6 regions, with the Mountain and Southeast regions having the highest regional reporting of new cases of cancer (69% and 55%, respectively) and the Northeast and Pacific regions having the lowest (47% each). Approximately 96% of patients received their treatment at the reporting hospital. The 4 most common carcinomas were breast (15.7%), lung (14.6%), prostate (14.2%), and colon (7.5%) and comprised the majority of new cases. Trends in patterns of care for breast carcinoma were analyzed for possible bias in the 1988 and 1993 periods. When hospitals reporting only in 1988 or in 1993 were compared with hospitals reporting at both time points, the only differences were small differences in ethnic participation. These differences were less than 1.5% in the proportion of African Americans reported in the different time periods. There were no significant differences in the downstaging of breast carcinoma, or the role of conservative surgery or adjuvant radiation therapy. CONCLUSIONS: The NCDB is a cancer management and outcomes data base for health care organizations that presently comprises 52% of the estimated new cases in the U.S. This will increase to 80% as the approved hospitals of the Commission on Cancer are required to report to the NCDB. Comparison of breast carcinoma findings at two time periods appeared similar regardless of hospital reporting set (i.e., set of hospitals reporting for one period versus both periods).

Adolescent↗