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PubMedDate not supplied

Verification of data reported by practices for a study of spontaneous abortion.

Little is known about the accuracy of data reported in practice based primary care research. The Ambulatory Sentinel Practice Network (ASPN) undertook a 100% audit of 226 patients included in a study of spontaneous abortion (SAB). The audit was conducted to assess the feasibility of conducting audits in primary care research networks dispersed over large geographic areas, verify that patients met inclusion criteria, and assess the frequency of reporting errors using the medical record as a standard. Of the originally reported SABs, 24% could not be verified. The overall error rate was 4.5%, a total of 106 errors out of a possible 2,361. Seventy percent of these errors came from five of the 34 participating practices. Sixty-six percent of the records were error-free. Seventy-seven percent of the errors were associated with problems with methods and clustered into three categories: gravidity, gestational age, and dilation and curettage (D&C). According to this audit, the data reported by the practices for research purposes were very similar to the data found in the medical record.

Abortion, Spontaneous↗
PubMed1996

The accuracy of Scottish Morbidity Record (SMR1) data for identifying hospitalised stroke patients.

OBJECTIVE: To assess the accuracy of the Scottish Morbidity Record (SMR1) data for stroke by comparing patients with a principal ICD-9 code of stroke on their SMR1 with those registered on our hospital-based stroke register (the Lothian Stroke Register [LSR]). We analysed why false positive and false negative SMR1 cases of stroke arose. We also compared two measures of outcome (death within 30 days, and proportion of patients discharged home within 56 days) in the group with verified stroke with those identified by SMR1 data. DESIGN: Retrospective, observational study. SETTING: A university teaching hospital. SUBJECTS: (i) LSR group. We aimed to register all patients admitted to the medical directorate of our hospital with a stroke over a 36 month period. (ii) SMR1 group. All patients with a principal ICD-9 code of stroke on their SMR1 return for the same period. RESULTS: 566 strokes were registered on the LSR; 84 (15%) of these did not have a principal code of stroke on their SMR1. A further 75 patients not registered on the LSR, but who had a principal code of stroke on their SMR1, were identified; 39 of these had suffered a stroke, 28 had not, and no data were available for eight. Thus, including these missing eight as assumed strokes, the total number of verified strokes was 613; the sensitivity of the SMR1 data was 86%, the specificity 99.9%. Many of the SMR1 false positive and negative cases arose because of inaccurate or misleading diagnostic terms used by medical staff. There were no significant differences for the two outcome measures between the verified group and the SMR1 group. CONCLUSIONS: Routinely collected SMR1 data for stroke in our hospital was reasonably accurate, but this result may not be widely generalisable as hospitals use different methods of coding. Inadequate data provided by clinicians was an important source of error, and should be correctable with better education. Despite the inaccuracies of the system, based on our results, the SMR1 data are probably a satisfactory way of identifying specific diagnostic groups for large scale audit.

Cerebrovascular Disorders↗
PubMed1998

Validity and accuracy of interview and diary data on children's medical utilisation in The Netherlands.

STUDY OBJECTIVE: To assess the validity and accuracy of children's medical utilisation estimates from a health interview and diary and the possible consequences for morbidity estimates. The influence of recall bias and respondent characteristics on the reporting levels was also investigated. DESIGN: Validity study, with the medical record of the general practitioner (GP) as gold standard. In a health interview and three week diary estimates of medical utilisation of children were asked and compared with a GP's medical record. SETTING: General community and primary care centre in the Netherlands. PARTICIPANTS: Parents of 1,805 children and 161 GPs. MAIN RESULTS: The sensitivity of the interview (0.84) is higher than the diary (0.72), while specificity and kappa are higher in the diary (0.96; 0.64) than in the interview (0.91; 0.5-8). Recall bias, expressed as telescoping and heaping, is present in the interview data. Prevalence estimates of all morbidity are much higher in the interview, except for skin problems. Compared with a parental diary more consultations are reported exclusively by the GP for children from ethnic minorities (OR 1.6), jobless (OR 2.3), and less educated mothers (OR 2.6). CONCLUSIONS: Estimates of medical utilisation rates of children are critically influenced by the method of data collection used. Interviews are prone to introduce recall bias, while diaries should only be used in populations with an adequate level of literacy. It is recommended that medical records are used, as they produce most consistent estimates.

Child↗
PubMed1996

Analysis of diaphragm EMG signals: comparison of gating vs. subtraction for removal of ECG contamination.

The diaphragm electromyogram (EMGdi) conveys information relating to the mechanisms of respiration; however, electrocardiogram (ECG) contamination can compromise the accuracy of data derived from this signal. We examine the EMGdi recorded from anesthetized spontaneously breathing dogs via implanted electrodes to assess the extent of the error introduced by the ECG contamination and the effectiveness of ECG gating in reducing this error. Because ECG subtraction has been shown to generate accurate results for such applications, it is used as the gold standard. Analysis of variance methods are employed to compare results derived from the EMGdi data after ECG subtraction with corresponding results derived from the original data and from the data after ECG gating. Estimates of EMGdi variables obtained by using subtraction and gating techniques were not significantly different, indicating that gating can be employed on these signals to reduce ECG contamination without affecting the accuracy of the derived data. Results also show that at EMG-to-ECG power ratios > 13.3 dB, ECG contamination does not significantly affect estimates of the EMGdi variables.

Animals↗
PubMed2005

Assessment of approximate string matching in a biomedical text retrieval problem.

Text-based search is widely used for biomedical data mining and knowledge discovery. Character errors in literatures affect the accuracy of data mining. Methods for solving this problem are being explored. This work tests the usefulness of the Smith-Waterman algorithm with affine gap penalty as a method for biomedical literature retrieval. Names of medicinal herbs collected from herbal medicine literatures are matched with those from medicinal chemistry literatures by using this algorithm at different string identity levels (80-100%). The optimum performance is at string identity of 88%, at which the recall and precision are 96.9% and 97.3%, respectively. Our study suggests that the Smith-Waterman algorithm is useful for improving the success rate of biomedical text retrieval.

Algorithms↗
PubMed2006

Teledermatology research review.

Teledermatology consultations can be performed using either store-and-forward or real-time technology. The best-studied aspect of teledermatology is diagnostic reliability, also known as diagnostic agreement. A good level of diagnostic reliability is achieved by dermatologists using both store-and-forward and real-time modalities and is comparable to that found between clinic-based examiners. Less information is available regarding diagnostic accuracy. Current data suggest that teledermatologists reviewing store-and-forward consults achieve accuracy comparable to that of clinic-based dermatologists. When store-and-forward consult systems are used, approximately one in four in-person clinic appointments are averted. Real-time consult systems avoid the need to schedule approximately one in two clinic visits. Store-and-forward technology results in timelier interventions for patients when compared to a conventional referral process. To date, surveys of both store-and-forward and real-time teledermatology consult modalities suggest that patients, referring clinicians, and dermatologists are all highly satisfied with teledermatology consults. Very little has been published about the economic impact of store-and-forward teledermatology, whereas several studies have evaluated real-time modalities. Teledermatology has ranged from a cost-saving strategy to an intervention that incurs greater costs than conventional care, depending on the health care setting and economic perspective. Future research focusing on diagnostic accuracy, clinical outcomes using clinical course or disease status as outcome measures, development of reliable and valid teledermatology-specific survey instruments, and economic analyses that assess cost-effectiveness will help guide future teledermatology program assessments and policy.

Attitude of Health Personnel↗
PubMedDate not supplied

Can we monitor socioeconomic inequalities in health? A survey of U.S. health departments' data collection and reporting practices.

OBJECTIVE: To evaluate the potential for and obstacles to routine monitoring of socioeconomic inequalities in health using U.S. vital statistics and disease registry data, the authors surveyed current data collection and reporting practices for specific socioeconomic variables. METHODS: In 1996 the authors mailed a self-administered survey to all of the 55 health department vital statistics offices reporting data to the National Center for Health Statistics (NCHS) to determine what kinds of socioeconomic data they collected on birth and death certificates and in cancer, AIDS, and tuberculosis (TB) registries and what kinds of socioeconomic data were routinely reported in health department publications. RESULTS: Health departments routinely obtained data on occupation on death certificates and in most cancer registries. They collected data on educational level for both birth and death certificates. None of the databases collected information on income, and few obtained data on employment status, health insurance carrier, or receipt of public assistance. When socioeconomic data were collected, they were usually not included in published reports (except for mothers educational level in birth certificate data). Obstacles cited to collecting and reporting socioeconomic data included lack of resources and concerns about the confidentiality and accuracy of data. All databases, however, included residential addresses, suggesting records could be geocoded and linked to Census-based socioeconomic data. CONCLUSIONS: U.S. state and Federal vital statistics and disease registries should routinely collect and publish socioeconomic data to improve efforts to monitor trends in and reduce social inequalities in health.

Birth Certificates↗
PubMed2000

CALINX (California Information Exchange): a multi-stakeholder statewide initiative to improve healthcare information flows.

Given the diffusion of responsibilities for gathering and reporting healthcare information in a managed care environment, California stakeholders are taking concrete steps to break the deadlock on data and information flows that has characterized the industry for some time. The California Information Exchange (CALINX) was established to facilitate the implementation of the Health Insurance Portability and Accountability Act (HIPAA) standards in California and to create trust for data exchange between trading partners, without which data exchange still will not occur. Strategic directions are set by the chief executives of key associations and organizations representing purchasers, plans, providers, and consumers. Multi-stakeholder workgroups have produced detailed data guidelines for the HIPAA standards along with rules for exchange of key data sets between trading partners. These rules address frequency, timeliness, and accuracy of data submission. Both the data guidelines and the rules have been tested in live demonstration projects, and the results of these projects have been reported to substantiate the business case for implementation. Further incentives are being built into contracts between purchasers and plans, and between plans and providers. CALINX is currently promoting widespread adoption of the data guidelines and rules for exchange with all members of the industry.

California↗
PubMed1959

Food hypersensitivity; correlation of intradermal skin tests with clinical allergenicity.

A study was made to determine how well the results of skin tests for sensitivity to various foods agreed with observation of clinical reactions to those foods. Test reactions were divided into several categories-negative, and 1, 2, 3 or 4 plus. Then the strong reactions, that is the 3 and 4 plus reactions, the milder reactions and the negative results were studied separately to determine the agreement of results, in each category, with the clinical response. Wide variations were noted. For some foods the agreement was high, for others low. For some foods, the agreement was high in some categories of reaction, low in others. For example, negative results of skin test might match with nonreaction to the food clinically in a high proportion of cases, and 3 or 4 plus reaction to skin test might be in close agreement with the incidence of distress upon ingestion of the food, yet for the same food there might be very poor correlation between mild reaction to skin test and clinical response. This being the case, accuracy of skin tests cannot be determined simply by combining all data on reactions, of whatever degree, and taking the aggregate of agreement in all categories as an index of the validity of the test. Each category of reaction must be considered separately.Combined data and categorized data on accuracy of skin tests for sensitivity to 26 foods were tabulated in the present study.

Allergens↗
PubMed1996

Secondary structure determination of proteins in aqueous solution by infrared spectroscopy: a comparison of multivariate data analysis methods.

The accuracy of the secondary structure prediction from an infrared spectra data base of 39 proteins with known X-ray structure was investigated by different methods of multivariate data analysis. The best agreements with the secondary structure determined by X-ray crystallography are obtained if both the amide I and amide II bands are used for calibration. With optimized parameters the methods singular value decomposition, partial least squares, and ridge regression yield similar results. As judged by the standard error of prediction, the secondary structure elements helix and beta-sheet can be predicted with the highest accuracy. Small data sets of less than 20 protein spectra, which exhibit the variance in secondary structure content of the whole set, can pretend an increased prediction accuracy only if column cross-validation is used as reference; however, with these calibration sets the average secondary structure prediction of all 39 proteins is debased. The hydrogen-bonded turns or bridges are predicted with higher accuracy than the assigned secondary structure types helix and beta-sheet.

Multivariate Analysis↗
PubMed1995

General practice data retrieval: the Northern Ireland project.

OBJECTIVE: To develop an epidemiological database of morbidity in the community as presented to general practitioners and to support epidemiological research in general practice. DESIGN: The project is a sentinel network of 23 general practices in Northern Ireland that report the incidence of a list of selected diseases to a central unit for analysis. RESULTS: Results are presented for depression, diabetes, and myocardial infarction. The age--sex distributions of diabetes and myocardial infarction are comparable with other published data but the incidence of depression is under estimated. CONCLUSIONS: The importance of complete accuracy of data reported within sentinel networks depends on the purposes for which information is to be used. For some diagnoses, such as diabetes and acute myocardial infarction, the accuracy of the reported incidence is high while for other diseases, such as depression, where diagnostic behaviour varies more between doctors, the figures are much less reliable.

Adolescent↗
PubMed1973

Use of mailed questionnaire data in a study of swine congenital malformations.

A study was designed to evaluate the representativeness and accuracy of data collected on swine birth defects by mailed questionnaire. The study was conducted in the three contiguous counties of Johnson, Lafayette and Pettis in west central Missouri. A personal interview survey and an examination of malformed pigs were used to validate mailed questionnaire data which estimated the frequency and distribution of malformations observed in pigs over a six month period. This period between April and September 1970 was defined as the study period. The results were compared to a previous six month period (April-September 1969), or baseline period, when only the mailed questionnaire was used. The frequency and distribution of the reported malformations by type did not differ significantly (at the p=0.05 level) between the study period (70.4% response) and the baseline period (31.3% response). Evaluation of this and additional data collected during the study suggested that the mailed questionnaire can be used effectively to estimate the frequency and distribution of swine malformations within a defined geographic area.

Animals↗
PubMed2005

Identifying and distinguishing cases of parkinsonism and Parkinson's disease using ICD-9 CM codes and pharmacy data.

Administrative databases have the potential to assess quality and cost of care for parkinsonism and Parkinson's disease. However, the validity of findings is limited by our understanding of how cases are identified. Patient records listing International Classification of Diseases, Version 9, Clinical Modification (ICD-9 CM) codes for parkinsonism (n = 2,076) and dopaminergic medications (n = 2,798) were pulled from fiscal years 1999 to 2001 for patients in the Pacific Northwest Veterans Administration. Samples of these records (n = 397) and records without these ICD-9 CM codes (n = 500) were reviewed, and clinical data were extracted. The accuracy of administrative data to identify and distinguish between Parkinson's disease and parkinsonism was calculated. A total of 37.9% of parkinsonism cases were detected using pharmacy data and ICD-9 CM codes compared to 18.7% by using ICD-9 CM codes alone. The ICD-9 CM code for paralysis agitans (332.0) did not distinguish between probable Parkinson's disease and other causes of parkinsonism, whereas the ICD-9 CM code for degenerative basal ganglia disorder (333.0) predicted having secondary parkinsonism (odds ratio [OR] = 5.0) as well as dopa-responsiveness in patients without secondary parkinsonism (OR = 4.5). Administrative data are limited in the ability to identify parkinsonism. The ICD-9 CM code, 332.0, which is generally considered the code to identify Parkinson's disease, did not distinguish between parkinsonism and Parkinson's disease.

Confidence Intervals↗
PubMed1997

Partial volumes and compressibilities of extended polypeptide chains in aqueous solution: additivity scheme and implication of protein unfolding at normal and high pressure.

An empirical additivity method for calculation of the partial volumes and adiabatic compressibilities of extended oligo- and polypeptides having arbitrary amino acid compositions has been developed and tested by comparison with available experimental data. Its accuracy is the best among the known empirical approaches. Comparison of experimental data on protein denaturation with the results of calculation allows one to discriminate between the unfolded and molten globule states of globular proteins and to estimate the extent of unfolding. For the first time, experimental nonlinear data for the volume-pressure relationship in proteins and model compounds have been used to interpret the high-pressure denaturation of proteins. It has been shown that the two denatured states, molten globule and unfolded ones, can be attained by a pressure rise: the molten globule state by moderate pressure and the unfolded one by high pressure. The relationship between volumetric properties and hydration is briefly discussed.

Peptides↗
PubMed2000

Behavioural implications of alarm mistrust as a function of task workload.

The research was conducted to investigate the effect of increasing primary task and alarm workload on alarm mistrust as reflected by alarm and primary task performances. A total of 126 undergraduate students performed a complex psychomotor task battery three times, with the number of concurrent tasks increasing each time. During their performance, the students were required to react to an alarm system (including visual and auditory components) of questionable reliability. Depending on the group to which participants were assigned, the alarm presentation rate constituted a low-, medium- or high-workload condition. Alarm response data (times, frequencies, accuracies) and primary task data (tracking error) were analyzed to assess performance differences as a function of primary and secondary task workload levels. Results generally supported the hypotheses: increasing primary task and alarm task workload degraded alarm response performance. Also, response frequencies supported earlier research suggesting that participants 'probability match' their response rates to alarm system reliability. The results are discussed with regard to the cry-wolf effect, attention theory and alarm system design.

Analysis of Variance↗
PubMed1979

Statistical analysis of method comparison data. Testing normality.

A Lilliefors test of normality has been applied to data from precision and accuracy studies. Most data sets tested as non-normal. Simulation studies showed that the test is extremely sensitive to the rounded, narrowly distributed data that are typical of method performance studies in clinical chemistry. The Lilliefors test can be modified to be applicable to rounded data so that it gives fewer indications of non-normality. The authors conclude that the selection of a test of normality requires careful study of the properties of the test. Otherwise, the subsequent choice between parametric and nonparametric statistics may not be meaningful.

Chemistry, Clinical↗
PubMed2002

Validity of cancer registry data for measuring the quality of breast cancer care.

BACKGROUND: Various groups have called for a national system to monitor the quality of cancer care. The validity of cancer registry data for quality of cancer care has not been well studied. We investigated the validity of such information in the California Cancer Registry. METHODS: We compared registry data associated with care with data abstracted from the medical records of patients diagnosed with breast cancer. We also calculated a quality score for each subject by determining the proportion of four evidence-based quality indicators that were met and then compared overall quality scores obtained from registry and medical record data. All statistical tests were two-sided. RESULTS: Records of 304 patients were studied. Compared with the medical record data gold standard, the accuracy of registry data was higher for hospital-based services (sensitivity = 95.0% for mastectomy, 94.9% for lumpectomy, and 95.9% for lymph node dissection) than for ambulatory services (sensitivity = 9.8% for biopsy, 72.2% for radiation therapy, 55.6% for chemotherapy, and 36.2% for hormone therapy). On average, quality scores calculated from registry data were 11 percentage points (95% confidence interval [CI] = 9 to 13 percentage points, P<.001) lower than those calculated from medical record data. Quality scores calculated from registry data were 5 percentage points (95% CI = 3 to 7 percentage points) lower for patients with stage I breast cancer, 16 percentage points (95% CI = 12 to 20 percentage points) lower for patients with stage II breast cancer, and 20 percentage points (95% CI = 8 to 32 percentage points) lower for patients with stage III breast cancer than were corresponding scores calculated from medical record data (all P<.001). The greater difference in quality scores for stage II and III patients revealed that disease severity and setting of care affected the validity of registry data. CONCLUSIONS: Cancer registry data for quality measurement may not be valid for all care settings, but registries could provide the infrastructure for collecting data on the quality of cancer care. We urge that funding be increased to augment data collection by cancer registries.

Age Factors↗