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At least 451 records · Page 25Linked to original sources
PubMed1998

Staged diabetes management: computerizing a disease state management program.

Recently, the Diabetes Control and Complication Trial (DCCT) and other similar studies have demonstrated that near-normalization of blood glucose in diabetes will reduce complications up to 75% but translation of these results into practice has been difficult. In an attempt to help provide the best possible control of patients with diabetes, we have produced an attempt to help provide the best possible control of patients with diabetes, we have produced a new disease state management system for diabetes, called "Staged Diabetes Management" (SDM), implemented it in over 100 sites worldwide, and developed a computer program to simplify its use. SDM, designed to change the way we deal with patients with diabetes, is based upon five principles: (1) community involvement in setting care guidelines; (2) negotiation of goals with patients; (3) appropriate timelines for therapeutic success; (4) use of flowcharts for medical decisions; and (5) evaluation of the program. SDM is designed to be altered by a community to meet its needs and resources. It encourages primary care physicians to deliver better diabetes care using a team approach and to refer patients with diabetes to specialists when appropriate. It has a complete set of materials for communities, individual health care providers and patients. SDM has been tested for changes in structure, process and outcomes. A meta-analysis of seven clinical trials with over 500 patients has shown a time-weighted average fall in hemoglobin A1c of 1.7 points (equivalent to a drop in mean blood glucose of about 3.5 mM or 60 mg/dL). Preliminary pharmacoeconomic analysis demonstrates a lifetime cost saving of over $27,000 per patient. A computer program has been developed for the Microsoft Windows environment that contains a client-server database, based upon DiabCare, for the data file structure.

Adult↗
PubMed1999

Genetic evaluation for length of productive life with censored records.

This study was conducted to investigate the impact of censoring on the accuracy of sire evaluation for the length of productive life estimated by means of survival analysis using simulated and real dairy cattle data from the Swiss Braunvieh population. Data were simulated under a Weibull model with two fixed effects and a random sire effect with a sire variance of 0.04. Two different family structures investigated were 1000 sires with 10 daughters each and 200 sires with 50 daughters each. Sires were assumed to be related through their sires. The reference data were generated assuming no censoring. Sire effects were estimated from the reference data with and without considering the relationships among sires and referred to as the estimated transmitting abilities (ETA) of sires. The impact of censoring on accuracy of ETA and ranking of sires was investigated by computing rank correlations among true and estimated sire effects and among estimated sire effects from the reference data and from several different data files with increased proportion of censored records. Estimated transmitting abilities were generally more accurate with a large number of daughters. The rank correlations among the ETA of sires from the data with censored records and the ETA from the reference data decreased with an increased proportion of censored records. Considering relationships among sires resulted in higher rank correlations when the proportion of censored records was large. With 50 daughters per sire, accuracy of 70% can be achieved approximately 2 yr after first calving of the daughters with about 50% censored records. With the real data, a rank correlation with the ETA of sires from the reference data of 0.70 to 0.80 can be achieved with about 65% of records censored and about 2.5 yr after the first calving of the youngest daughters of the sires.

Animals↗
PubMedDate not supplied

[The use of the computer in the neonatal intensive therapy unit: the current and prospective aspects].

The Authors assert that computer can give an adjunctive value to our abilities, improve the punctuality of own service, lighten the duties of routine (leaving free time for own-self or for adjournment). We have noticed a gradual but continuous increase of the use of the computer in the last years in hospital particularly in the Neonatology department and in the NICU, even because in these departments the data to compare are numerous. In the Brindisi's NICU since 1/7/1986 there has been a process of progressive increase of the use of the computer, based on three directions: filing data of the patients, computer-assisted management of the treatment of RDS, computer-assisted follow-up of the risk-baby, and management of the resources. Moreover are reported possibilities of future applications, as records of diagnosis and helped therapy, interface with medical equipment, linking with databank and with the hospital's mainframe.

Computer Systems↗
PubMed1991

[Electronic data processing data bank for vascular surgery as a multiple site system with network connection].

A clinical database, using FileMaker Pro and a network of APPLE Macintosh computers, were created for a vascular surgical unit. The databank presented here is based on proven, routine working procedures of the department. An easily learnable entry facility with hands-on, screen-oriented users' guide and help data file provide easy operability and highly efficient databank capability, along with great flexibility. This criterial and user-friendly features make staff acceptance and compliance readily achievable, thus assuring comprehensive data entry.

Computer Communication Networks↗
PubMed2000

The sleep data transfer between remote and central sites.

Sleep laboratory have long waiting lists due to the high prevalence of sleep disorders and the low availability of centers. One possibility for improving patient care is an ambulatory recording at home or in a distributed center. Then the data recorded must be transferred for analysis in the specialized center. Similarly, an application is needed for the transfer of raw data when the recordings are made by a health care provider sending sleep technologists to set-up the equipment in the patient's home. It is ethically preferable that the analysis be made by a physician from an independent organization from the provider to avoid any conflict of commercial interest with the provider whose main purpose is delivering therapeutic equipment (CPAP, oxygen...). The objectives were to set-up and test the transfer of sleep data files by ISDN lines between a health care provider and an expert sleep center. The application had to take into account a wide geographical dispersion of patients, general practitioners and medical experts. For that reason, it was decided to use existing Internet Web technology to facilitate portability and interoperability, reduce design time and costs and speed up deployment. The healthcare provider is the collecting site of ambulatory sleep recordings performed at the patient's home by the sleep technician of the provider. The raw data are sent to the sleep center for expert analysis. The methods used were: a PC set-up with a Gazel pro 2B PCI board, a commercially available file transfer software (DT Winstutel from ORSENNA) and an ISDN connection at 128 Kbps. The transfer security needs a set-up to maintain the confidentiality of the personal data transmitted: this is ensured through an identification sequence with several encrypted passwords. The duration of the transfer between Paris and Clamart has been tested for a 44 Moctets file: it took 66 min instead of a theoretical duration of 50 min. This difference was explained by a slower transfer rate (93 Kbps) instead of 128 Kbps. The cost of the transfer has been estimated at 5.4 Euro. This cost can be reduced by subscribing higher transfer tariffs. It amounts to 4.5% of the total cost of the ambulatory procedure at a value of 0.12 Euro per Moctet.

Computer Security↗
PubMed2004

Tools and strategies for processing diffusion-ordered 2D NMR spectroscopy (DOSY) of a broad, featureless resonance: an application to methylaluminoxane (MAO).

UNLABELLED: DOSY has been extremely successful in many studies of molecular weight distributions, especially when the components are separable along the chemical shift axis. However, an unresolved NMR resonance yields the familiar problem of overlapping exponential decays. In a study of methylaluminoxane (MAO), a set of data processing and simulation tools were developed: read Bruker data files (Matlab); preliminary non-linear least-squares fit with f-test (Matlab); movie generation of the fits (Matlab); conversion of diffusion coefficients to molecular masses through molecular volumes (Gaussian-98); and simulation of DOSY data sets for various molecular mass distributions (Mathematica). These tools are presented here and briefly compared with other DOSY analysis methods. ELECTRONIC SUPPLEMENTARY MATERIAL: Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00216-003-2457-1. The following Matlab and Mathematica files are made available: Plot_Raw_DOSY.m, Fit_Two_Component.m (which calls One_Gaussian_LEASTSQ.m, Two_Gaussian_LEASTSQ.m, and pFTest.m), and DOSY_theory.nb. Note: Matlab v5.2 optimization toolbox, as supplied, lacked a confidence interval subroutine; upon our request, confint.m was provided to the authors by Mathworks, Inc. Newer versions of Matlab have a similar program already included in the optimization.

Journal Article↗
PubMed2000

Umbilical artery catheters in the newborn: effects of catheter materials.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To determine whether the material used for construction of an umbilical arterial catheter influences the frequency of ischemic events, aortic thrombosis, mortality or necrotising enterocolitis in newborn infants. SEARCH STRATEGY: Randomized and quasi randomized controlled trials of umbilical catheterization use were obtained from the following sources: 1. Effective Care of the Newborn Infant, edited by JC Sinclair and MB Bracken. 2. Medline Search using Melvyl Medline Plus and the keyword headings "Umbilic#", "Catheter#" and subject heading "Infant, Newborn" 3. Search of personal data files SELECTION CRITERIA: Randomized studies in newborn infants of any birthweight or gestation. Comparison of different catheter materials. Clinically important end points such as ischemic events, aortic thrombosis, or catheter occlusion. DATA COLLECTION AND ANALYSIS: One non-randomized and one randomized study were retrieved. MAIN RESULTS: There were no significant effects of substituting a heparin bonded polyurethane catheter for the standard PVC catheter. The non-randomized study suggested that there may possibly be a benefit of using a catheter constructed from Silastic, with a reduction in aortic thrombosis. REVIEWER'S CONCLUSIONS: There are no demonstrated clinically relevant differences in outcomes between the use of PVC catheters and other materials. Therefore, other considerations such as price and ease of availability may dictate the catheter chosen. An adequately powered randomized comparison of silastic to PVC should be performed.

Catheterization↗
PubMed2004

Factors associated with higher levels of injury severity in occupants of motor vehicles that were severely damaged in traffic crashes in Kentucky, 2000-2001.

OBJECTIVES: The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000-2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupant's vehicle was severely damaged. METHODS: This study probabilistically linked Kentucky's statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either "severe" or "very severe" damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 software, and the scores were stratified into the following categories: critical (>24), severe (15-24), moderate (9-14), and mild (<9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature. RESULTS: Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater. CONCLUSIONS: Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.

Accidents, Traffic↗
PubMed1985

Computer-aided construction of nucleic acid restriction maps using defined vectors.

A new algorithm is described that will rapidly produce restriction maps of cloned DNA fragments. Information concerning the vector is stored as a data file and used in constructing probable maps. As the program is based upon a permutation analysis it has two primary uses. First, preliminary restriction maps can be created from fragment length data as a starting point for further analysis. Second, existing maps can be confirmed as being highly probable, and other probable maps examined to ensure certain combinations have not been overlooked. Although primarily designed for linear vectors, the program can be used to calculate circular maps.

Algorithms↗
PubMed2003

Nationwide trends in rates of utilization of noninvasive diagnostic imaging among the Medicare population between 1993 and 1999.

PURPOSE: To determine current utilization rates and recent nationwide trends for noninvasive diagnostic imaging (NDI) among the Medicare population. MATERIALS AND METHODS: Medicare Part B claims data files from 1993, 1996, and 1999 were analyzed for all procedure codes related to NDI. NDI codes were grouped into 22 imaging categories, as well as seven imaging modality groups. The data were analyzed to determine the overall nationwide utilization and relative value unit (RVU) volume and rates and changes in utilization rates and RVU rates between 1993 and 1999 for the Medicare fee-for-service population, which included approximately 33 million enrollees per year. RESULTS: The overall utilization rate for all NDI in 1999 was 324,974 examinations per 100,000 enrollees. Conventional radiography was the most utilized imaging technology (55.5%), followed by ultrasonography (US) (20.5%), computed tomography (CT) (8.8%), mammography (6.0%), nuclear imaging (5.2%), magnetic resonance (MR) imaging (2.6%), and bone densitometry (1.5%) (percentages do not add up to 100% due to rounding). In the 6-year interval from 1993 to 1999, the rate of NDI utilization increased 3.8%. The utilization rate for conventional radiography decreased 13.7%, while that of all other modalities increased a combined total of 39.1%. During this 6-year period, RVU rates per 100,000 increased 14.6%, with RVUs for MR imaging increasing 76.6%; those for nuclear imaging, 38.7%; those for CT, 28.3%; and those for US, 24.2%. CONCLUSION: A 3.8% increase in the rate of NDI utilization occurred during the 6-year period between 1993 and 1999. A considerably larger increase in RVU rates (14.6%) occurred during the same time period.

Diagnostic Imaging↗
PubMed2006

Association of schizophrenia and autoimmune diseases: linkage of Danish national registers.

OBJECTIVE: Individuals with schizophrenia and their relatives tend to have either higher or lower than expected prevalences of autoimmune disorders, especially rheumatoid arthritis, celiac disease, autoimmune thyroid diseases, and type 1 diabetes. The purpose of the study was to estimate the association of schizophrenia with these disorders as well as a range of other autoimmune diseases in a single large epidemiologic study. METHOD: The Danish Psychiatric Register, the National Patient Register, and a register with socioeconomic information were linked to form a data file that included all 7,704 persons in Denmark diagnosed with schizophrenia from 1981 to 1998 and their parents along with a sample of matched comparison subjects and their parents. The data linkage required that the autoimmune disease occur before the diagnosis of schizophrenia. RESULTS: A history of any autoimmune disease was associated with a 45% increase in risk for schizophrenia. Nine autoimmune disorders had higher prevalence rates among patients with schizophrenia than among comparison subjects (crude incidence rate ratios ranging from 1.9 to 12.5), and 12 autoimmune diseases had higher prevalence rates among parents of schizophrenia patients than among parents of comparison subjects (adjusted incidence rate ratios ranging from 1.3 to 3.8). Thyrotoxicosis, celiac disease, acquired hemolytic anemia, interstitial cystitis, and Sjögren's syndrome had higher prevalence rates among patients with schizophrenia than among comparison subjects and also among family members of schizophrenia patients than among family members of comparison subjects. CONCLUSIONS: Schizophrenia is associated with a larger range of autoimmune diseases than heretofore suspected. Future research on comorbidity has the potential to advance understanding of pathogenesis of both psychiatric and autoimmune disorders.

Age of Onset↗
PubMed1998

Compare your Medicare utilization to these geographic, DRG-based benchmarks.

Data File: Medicare inpatient utilization benchmarks. Actuarial consultants Milliman & Robertson find 53% of Medicare inpatient bed days nationally are medically unnecessary or better spent in other health care settings. Here are benchmark data on inpatient admission and bed days per 1,000 members in optimally managed health systems.

Actuarial Analysis↗
PubMed1993

PCS: an IBM-compatible microcomputer program for the analysis and display of voltage-clamp data.

A program for IBM-compatible microcomputers is described which facilitates the analysis and manipulation of voltage-clamp data. PCS accepts pCLAMP acquired data as well as data from a more generalized binary data file. This cursor-driven program permits four modes of analysis: peak detection, averaging, integration and curve fitting, with direct graphical feedback of the results. Graphs of analysis results, such as current versus voltage relations (I-V curves), with tabulated data can be concisely printed using a HP Laserjet III. Selected current traces may also be plotted using the HP Laserjet III or exported to an ASCII comma and quotation mark delimited file suitable for import to a spreadsheet program.

Animals↗
PubMed1997

Reproducibility test on a children's insole for measuring the dynamic plantar pressure distribution.

INTRODUCTION:: This study aimed to establish the reproducibility of a insole measuring system specifically designed for use inside children's shoes. It is important to carry out such an investigation before any measurements are taken in order to ensure that any errors associated with the system are known and quantified. The children's insole had 84 pressure sensors, compared to the adult insoles, with 99 pressure sensors. The sensor technology was essentially the same as used in the adult Pedar system, and incorporated capacitance-based pressure transducers. MATERIALS AND METHOD:: An eight year old boy, height 123 cm, weight 29 kg, was used in the study. Dynamic tests were carried out with the Pedar insole measuring system. The subject walked on a treadmill, at a speed comfortable for him (3 km/h), with the insoles placed between the foot and the shoe. No fixation of the insole to the shoe was used. Seven runs were completed, each with four tests recorded of more than twenty steps. In between each run the insoles were completely removed from the shoe and then replaced. A zero measurement was also taken before the continuation of the next run. Before analysis of the data, twenty steps were selected. The first two steps in each sequence were ignored and the following twenty steps were used in the analysis, ten each for the left and the right foot. Any additional steps recorded were also ignored. The average force for the test data file was initially noted, together with the local pressure for each of the forefoot, midfoot, heel and toe regions, for both the left and the right foot, separately. RESULTS:: The within test data and in-between test data when walking on a treadmill at constant speed was found to be reproducible (F(0.01)) for 6 out of 7 tests for the left and the right foot. The standard deviation of the average force for the left and the right foot was 3%. The 95% confidence intervals for the mean of the peak pressure in the total object was within 6% for the treadmill and free walking data. There was no significant difference between these data. The 95% confidence intervals for the mean of the peak pressure under the big toe was 9% for the treadmill data and 16% for the free walking data. CONCLUSIONS:: These results, together with other published data (McPoil et al. 1995) show that the pedar children's insole system provides accurate and reproducible measurements of the dynamic plantar pressure distribution. The clinician can therefore use this system with confidence as a therapeutic or rehabilitative tool.

Journal Article↗
PubMed1997

The Genome Sequence DataBase version 1.0 (GSDB): from low pass sequences to complete genomes.

The Genome Sequence DataBase (GSDB) has completed its conversion to an improved relational database. The new database, GSDB 1.0, is fully operational and publicly available. Data contributions, including both original sequence submissions and community annotation, are being accomplished through the use of a graphical client-server interface tool, the GSDB Annotator, and via GIO (GSDB Input/Output) files. Data retrieval services are being provided through a new Web Query Tool and direct SQL. All methods of data contribution and data retrieval fully support the new data types that have been incorporated into GSDB, including discontiguous sequences, multiple sequence alignments, and community annotation.

Animals↗
PubMed2003

Family physician continuity of care and emergency department use in end-of-life cancer care.

BACKGROUND: Despite cancer patients preferring to spend their last days out-of-hospital, many make difficult visits to the emergency department (ED). Family physician continuity of care has been shown in some clinical situations to reduce ED utilization. OBJECTIVE: To determine if greater family physician continuity of care for cancer patients during the end-of-life is associated with less ED utilization. METHOD: This retrospective, population-based study involved secondary analysis of linked administrative data files for 1992 to 1997. Sources included the Nova Scotia Cancer Registry, Vital Statistics, the Queen Elizabeth II Health Sciences Center Oncology Patient Information System and Palliative Care Program (PCP), Hospital Admissions/Separation data, and Physician Services information. Subjects included adults with a recorded date of cancer diagnosis who died of cancer and who had made at least three visits to a family physician during their last 6 months of life. The relationship between total ED visits and family physician continuity of care, developed using the Modified Modified Continuity Index (MMCI), was examined using negative binomial regression with adjustments for survival, year of death, sex, age, cancer type, region, PCP admission, specialty visits, hospital days, death location, income quintile, and total ambulatory visits. RESULTS: In total, 8702 subjects made 11,551 ED visits (median = 1.0); median MMCI was 0.83. Adjusted results indicate those experiencing low continuity (MMCI < 0.5) made 3.9 times more ED visits (rate ratio [RR] = 3.93; 95% CI [CI] = 3.57-4.34) than those experiencing high continuity (MMCI > or = 0.8) and patients experiencing moderate continuity (MMCI = 0.5-0.8) made twice as many ED visits (RR = 2.28; CI = 2.15-2.42). CONCLUSION: Given this significant association between family physician continuity of care and ED visits during the end-of-life, and given international trends to reform primary care, active planning of strategies to facilitate such continuity should be encouraged.

Aged↗
PubMed2006

CARMA: A platform for analyzing microarray datasets that incorporate replicate measures.

BACKGROUND: The incorporation of statistical models that account for experimental variability provides a necessary framework for the interpretation of microarray data. A robust experimental design coupled with an analysis of variance (ANOVA) incorporating a model that accounts for known sources of experimental variability can significantly improve the determination of differences in gene expression and estimations of their significance. RESULTS: To realize the full benefits of performing analysis of variance on microarray data we have developed CARMA, a microarray analysis platform that reads data files generated by most microarray image processing software packages, performs ANOVA using a user-defined linear model, and produces easily interpretable graphical and numeric results. No pre-processing of the data is required and user-specified parameters control most aspects of the analysis including statistical significance criterion. The software also performs location and intensity dependent lowess normalization, automatic outlier detection and removal, and accommodates missing data. CONCLUSION: CARMA provides a clear quantitative and statistical characterization of each measured gene that can be used to assess marginally acceptable measures and improve confidence in the interpretation of microarray results. Overall, applying CARMA to microarray datasets incorporating repeated measures effectively reduces the number of gene incorrectly identified as differentially expressed and results in a more robust and reliable analysis.

Analysis of Variance↗
PubMed2001

Software scripts for quality checking of high-throughput nucleic acid sequencers.

We have developed a graphical interface to allow the researcher to view and assess the quality of sequencing results using a series of program scripts developed to process data generated by automated sequencers. The scripts are written in Perl programming language and are executable under the cgibin directory of a Web server environment. The scripts direct nucleic acid sequencing trace file data output from automated sequencers to be analyzed by the phred molecular biology program and are displayed as graphical hypertext mark-up language (HTML) pages. The scripts are mainly designed to handle 96-well microtiter dish samples, but the scripts are also able to read data from 384-well microtiter dishes 96 samples at a time. The scripts may be customized for different laboratory environments and computer configurations. Web links to the sources and discussion page are provided.

Base Sequence↗