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A decision support system for evaluating mastitis information.

A data-driven decision support system, MAST, was developed to summarize systematically the DHI data related to mastitis. MAST determines weaknesses and problems of a mastitis control strategy by pinpointing problem areas, highlighting the scope of the mastitis problem, providing reference values for comparison, offering potential solutions to problem areas, and monitoring changes in the control strategy. Advantages of a DHI data-driven system include accuracy of input data, fast execution speeds, access to untapped information available in DHI data, and a consistent analysis of data. An on-farm decision support system allows the evaluation of the mastitis control strategy at any time, which in turn increases the value of DHI information. The sequence of the graphical results allows users to understand intuitively the overall mastitis problems, find the potential origins, and assess their impact on the herd. Color-coded graphs with supplementary text allow for a rapid analysis of level and trends over time, as well as comparisons among parities, lactation stages, and active and culled cows.

Animals↗

[Attempted assessment of the incidence and cost of surgical treatment of inginal hernias in Poland in the years 2001-2002].

A comprehensive, up-to-date assessment of the incidence and treatment cost of inguinal hernias in Poland is made difficult by the lack of a central data registry and insufficient accuracy of the data available. Therefore, research was undertaken in order to evaluate the incidence and cost of inguinal hernia treatment in the years 2001-2002 in Poland. Survey-derived data was collected from Regional Health Funds operating similar data management systems in 2002 and the Regional Branches of the National Health Fund in 2003. The number of inguinal hernia repairs, length of hospital stay, as well as the cost of these procedures and the overall number of insured people in the region were assessed. Data was obtained from 11 units (Regional Health Funds, Branches of the National Health Fund). The length of hospital stay differed between individual Regional Health Funds. The annual cost of inguinal hernia treatment amounts to approximately 100 million PLN.

Ambulatory Surgical Procedures↗

The certification of suicide in eleven western states: an inquiry into the validity of reported suicide rates.

From Durkheim's time to the present social researchers interested in the problem of suicide have relied upon officially reported rates of suicide to develop and test their theories. Despite the fact that the validity of any theory rests upon the accuracy of its underlying data, the relative accuracy of reported suicide rates have rarely been questioned or systematically evaluated. This paper investigates the process of death certification as practiced by a sample of 191 coroners in 11 western states. Findings indicate extensive variation in the backgrounds, professional resources, operating procedures, and governing statutes of coroners and coroners' offices and in policies concerning the use of the suicide mode. Since the coroner is generally charged with the official responsibility for certifying the mode of death when unnatural mode is suspect, the extent of variation found here calls into question the validity and comparability of reported suicide rates.

Coroners and Medical Examiners↗

Factors influencing accuracy of screw displacement axis detection with a D.C.-based electromagnetic tracking system.

Recent technical improvements and cost reductions in electromagnetic motion tracking systems invite their application to motion axis determination in the surgical setting. After evaluation of the accuracy of a state-of-the-art D.C. electromagnetic tracking system, which generates complete three-dimensional kinematic outputs from just a single receiver, we calculated screw displacement axes (SDA's) from its source data. The accuracy of SDA determination from such source data was evaluated for various rotational increment sizes around a revolute joint. A novel smoothing procedure, customized for this type of source data, was developed, enabling SDA detection from incremental rotations of less than 1 deg, at an accuracy appropriate for intra-operative measurement of human joint motion. Examples of SDA determination are given for motion tracking of a ball joint and of the elbow articulation.

Electromagnetic Phenomena↗

Data compression methods for EEG.

Modem brain research experiments require the recording of large amounts of high-accuracy EEG data. Sampling frequency, bit resolution and number of channels are significantly larger than in routine clinical measurements. Because of this, the need of efficient signal compression has emerged. This paper presents a survey of available methods and explores some techniques, both lossy and lossless, for compressing EEG signals.

Algorithms↗

Data validation in an economic evaluation of surgery for colon cancer.

OBJECTIVES: This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer. METHODS: Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement. RESULTS: Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs. CONCLUSIONS: The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.

Colectomy↗

The burden of childhood tuberculosis and the accuracy of community-based surveillance data.

BACKGROUND: Inadequate surveillance and diagnostic difficulties compromise the quality of epidemiological data on childhood tuberculosis (TB). OBJECTIVE: To document the incidence of childhood TB and to evaluate the accuracy of community-based surveillance data in a high-burden setting. METHODS: This prospective observational study was conducted from February 2003 to October 2004 at five primary health care clinics in Cape Town, South Africa. Comprehensive surveillance was done to ensure that all children <13 years of age treated for TB were included. RESULTS: During the study period, 443 children (<13 years of age) received anti-tuberculosis treatment, of whom 389 (87.8%) were recorded in the TB treatment register. The TB incidence calculated from the TB treatment register was 441/100,000/year amongst children and 845/100,000/year amongst adults. Fifty-four children treated for TB were not recorded in the TB treatment register, including 21/28 (75%) children with severe disease. DISCUSSION: Children <13 years of age contributed 13.7% of the total TB burden, but experienced more than half (52.2%) the TB incidence recorded in adults. Community-based surveillance data excluded the majority of children with severe disease. The accuracy of surveillance data is an important consideration when describing the epidemiology of childhood TB or measuring the success of public health interventions.

Child↗

Estimating the accuracy of psychological scales using longitudinal data.

This article presents a method for estimating the accuracy of psychological screening scales using receiver operating characteristic curves and associated statistics. Screening scales are typically semicontinuous within a known range with distributions that are nearly symmetric when the target condition is present and highly skewed when the condition is absent. We model screening scale outcomes using truncated normal distributions that accommodate these different distributional shapes and use subject-specific random effects to adjust for multiple assessments within individuals. Using the proposed model, we estimate the accuracy of the Symptom Checklist as a measure of major depression from a repeatedly screened sample of patients.

Antidepressive Agents↗

Estimation of disease-specific costs in health insurance claims: a comparison of three methods.

OBJECTIVE: To compare the accuracy and validity of three different methods (Proportional Disease Magnitude method [PDM] with two different magnitude estimations: arithmetic means with correction by the authors; Proportional Allotment Estimator [PAE] by Tango; Maximum Likelihood Estimator [MLE] also by Tango) for estimating disease-specific costs in health insurance claims. METHODS: Application of the three methods to a computer-generated simulation dataset whose disease-specific costs were known and to actual outpatient claims whose disease-specific costs were unknown. OUTCOME MEASURES: For simulation data, the accuracy was assessed by correlation between known disease-specific costs and estimated disease-specific costs by the three methods. For actual claims, concurrent validity was assessed by inter-method correlations between pairs of the two methods. RESULTS: All three methods showed good agreement and accuracy with the simulation data but marked disagreement when they applied to actual claims. MLE yielded an aggregate total of disease-specific costs exceeding the actual total by 21.3% and showed negative disease-specific costs in 18 out of 154 categories. Inter-method correlations showed that PDM with PAE and MLE correlated most strongly (R2 = 0.9022) while the least correlation was observed for PDM with arithmetic means and MLE (R2 = 0.6861). CONCLUSION: MLE is not usable for claims analysis but PDM yielded good estimates with two different methods of magnitude estimation using actual claims.

Insurance Claim Reporting↗

Automated entry of nosocomial infection surveillance data: use of an optical scanning system.

Surveillance of nosocomial infections is the foundation of any infection control programme. One of the main obstacles to surveillance is the speed and accuracy of data collection and entry. To overcome this bottleneck, we instituted automated data capture and processing in a number of point-prevalence and continuous nosocomial infection surveillance programmes. The system incorporated a document scanner, form design and processing software (Formic for Windows version 2) and statistical analysis software SPSS (Statistical Products and Service Solutions). After designing the surveillance questionnaire, it was completed by putting an X or a numeral in the the appropriate boxes. Information was collected by the infection control nurse and/or by members of clinical staff depending on the type of surveillance being undertaken. Once the form was completed it was returned and scanned using a document scanner with automatic feed. The software read and evaluated the data on each page. Data from 16741 A4 sides of surveillance questionnaires were automatically processed in a total time of 37.3 hours. This system was found to have a 99.98% accuracy rate and it was estimated to be 22 times quicker than manual entry of data. Infection control teams who are required to carry out surveillance activities should consider automatic data-entry systems. The versatility of such systems makes it possible to achieve extensive surveillance with limited resources.

Cross Infection↗

Incremental prognostic accuracy of clinical, radionuclide and hemodynamic data in acute myocardial infarction.

A logical sequence of testing in evaluating prognosis early in acute myocardial infarction (AMI) would be to use clinical data first, then add noninvasive data and finally add invasive data. The incremental prognostic information concerning 1-year survival obtained from such a sequence in 107 patients with AMI was studied using logistic regression and receiver-operating characteristic curves. Cardiac mortality was 24% at 1 year. Clinical data obtained soon after admission (prior myocardial infarction, heart rate, blood pressure, age) were 78 +/- 5% accurate in the prediction of 1-year survival. The addition of radionuclide-estimated left ventricular ejection fraction or invasive hemodynamic data to the clinical model at this time improved prognostic accuracy to 84 +/- 5% (p = 0.05) and 87 +/- 4% (p = 0.007), respectively. The further addition of invasive data to the model containing clinical and left ventricular ejection fraction data provided a further increment in prognostic accuracy to 89 +/- 4%, whereas no significant increase in accuracy was seen on addition of left ventricular ejection fraction to the model containing clinical and invasive data. It is concluded that clinical data provide important prognostic information concerning late survival early in the course of AMI. This may be improved by the logical application of noninvasive and invasive studies at this time.

Adult↗

Accuracy and completeness of Medicare claims data for surgical treatment of breast cancer.

BACKGROUND: Although a number of studies have used Medicare claims data to study trends and variations in breast cancer treatment, the accuracy and completeness of information on surgical treatment for breast cancer in the Medicare data have not been validated. OBJECTIVES: This study assessed the accuracy and completeness of Medicare claims data for breast cancer surgery to determine whether Medicare claims can serve as a source of data to augment information collected by cancer registries. METHODS: We used the Surveillance, Epidemiology and End Results (SEER) Cancer Registry-Medicare data and compared Medicare claims on surgery with the surgery recorded by the SEER registries for 23,709 women diagnosed with breast cancer at > or =65 years of age from 1991 through 1993. RESULTS: More than 95% of women having mastectomies according to the Medicare data were confirmed by SEER. For breast-conserving surgery, 91% of cases were confirmed by SEER. The Medicare physician services claims and inpatient claims were approximately equal in accuracy on type of surgery. The Medicare outpatient claims were less accurate for breast-conserving surgery. In terms of completeness, when the 3 claims sources were combined, 94% of patients receiving breast cancer surgery according to SEER were identified by Medicare. CONCLUSIONS: The combined Medicare claims database, which includes the inpatient, outpatient, and physician service claims, provides valid information on surgical treatment among women known to have breast cancer. The claims are a rich source of data to augment the information collected by tumor registries and provide information that can be used to follow long-term outcomes of Medicare beneficiaries.

Breast Neoplasms↗

[Environment and health: an analysis of intra-urban differentials in the city of São Paulo, Brazil].

A field study undertaken in the city of S. Paulo is presented as part of the project Environment and Health in Developing Countries: An Analysis of Intra-Urban Differentials Using Existing Data financed by the Ministry of Foreign Affairs of the United Kingdom with academic support from the London School of Hygiene and Tropical Medicine (LSHTM). The research aim was to fill in the gaps in the information needed to establish associations between mortality, urbanization and the environment. Statistics were produced by means of existing data collected by city departments, research carried out by universities and census data. Data quality was assessed taking into consideration data coverage, accuracy, and sensibility to pinpoint deprived areas in the city of S. Paulo. Socioeconomic data were used to create a composite index for districts and subdistrict in order to form four socioeconomic zones. Mortality differentials between the zones by five broad age groups (0-4, 5-14, 15-44, 45-64 e 65+) and four ICD chapters (circulatory, respiratory, infectious and parasitic and external causes) are presented. The zoning used showed that 43.8% of S. Paulo residents live in areas under the worst socioeconomic conditions. Health data demonstrated that people living in this areas had higher rates of mortality then those living in the areas with the best conditions. Finally, excess mortality data are analyzed and suggested as a good method for allocating health resources.

Adolescent↗

Accuracy of rhythm classification using a data log system in implantable cardioverter defibrillators.

Because the presence or absence of symptoms alone may be insufficient to correctly diagnose the rhythm for which implantable cardioverter defibrillator therapy is delivered, we hypothesized that the addition of data log information available in Telectronics ATP 4210 may improve the accuracy of rhythm classification. With this system the recorded ventricular electrogram cycle length is reported on a beat-to-beat basis immediately before, during, and after the tachyarrhythmia is detected. Using this information recorded from the data log in 32 separate tachyarrhythmia episodes in 20 patients, we compared the sensitivity, specificity, and predictive accuracy of rhythm classification on the basis of symptoms alone, data log alone, and data log combined with symptoms. While classification based on symptoms alone is highly specific (10/10 episodes), it is insensitive and has an overall predictive accuracy of 53%. By contrast, data log is sensitive (90%) and specific (91%) with better predictive accuracy (94%) than symptoms alone (P = 0.002). The addition of symptoms to information on beat-to-beat cycle length from data log resulted in a slight increase in predictive accuracy.

Data Collection↗

Accuracy of the continuous glucose monitoring system in inpatient and outpatient conditions.

OBJECTIVE: To evaluate in inpatient and outpatient conditions, using only non-calibration data, the accuracy of the Continuous Glucose Monitoring System (CG-MS). RESEARCH DESIGN AND METHODS: Twelve, 21 and 20 type 1 diabetic patients participated in 3- day inhospital, 6-day ambulatory (i.e., 2 sensors worn consecutively) and 3-day ambulatory studies. Capillary glucose tests (7-8/day) served as comparisons. Pairs of data (excluding the 4 daily pairs used automatically by the CGMS for calibrations) were analyzed using correlation coefficient, error -grid analysis, and mean of absolute differences. RESULTS: Two third and half of the sensing days were qualified as "optimal", i.e., interpretable by the CGMS program in the inpatient and outpatient studies, respectively. Correlation coefficient was 0.92, 0.81 and 0.73 in the inpatient, 6 day outpatient and 3-day outpatient studies. 98%, 93% and 96% of the data fell in the A or B error-grid "clinically acceptable" zones. Mean absolute differences between sensor and glucometer values were 25 +/- 2, 34 +/- 5 and 32 +/- 5 mg/dl. CONCLUSION: CGMS may be used for assessment of glycemic trends, though accuracy is more in the range of glucometers than of laboratory tests. Inhospital utilisation improved accuracy and 6-day rather than 3-day sessions may be more appropriate to evaluate day to day reproducibility of glucose profile.

Automation↗

Quality of data regarding diagnoses of spinal disorders in administrative databases. A multicenter study.

The purpose of the present study was to evaluate the accuracy of data regarding diagnoses of spinal disorders in administrative databases at eight different institutions. The records of 189 patients who had been managed for a disorder of the lumbar spine were independently reviewed by a physician who assigned the appropriate diagnostic codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The age range of the 189 patients was seventeen to eighty-four years. The six major diagnostic categories studied were herniation of a lumbar disc, a previous operation on the lumbar spine, spinal stenosis, cauda equina syndrome, acquired spondylolisthesis, and congenital spondylolisthesis. The diagnostic codes assigned by the physician were compared with the codes that had been assigned during the ordinary course of events by personnel in the medical records department of each of the eight hospitals. The accuracy of coding was also compared among the eight hospitals, and it was found to vary depending on the diagnosis. Although there were both false-negative and false-positive codes at each institution, most errors were related to the low sensitivity of coding for previous spinal operations: only seventeen (28 per cent) of sixty-one such diagnoses were coded correctly. Other errors in coding were less frequent, but their implications for conclusions drawn from the information in administrative databases depend on the frequency of a diagnosis and its importance in an analysis. This study demonstrated that the accuracy of a diagnosis of a spinal disorder recorded in an administrative database varies according to the specific condition being evaluated. It is necessary to document the relative accuracy of specific ICD-9-CM diagnostic codes in order to improve the ability to validate the conclusions derived from investigations based on administrative databases.

Adult↗

Injury scaling at autopsy: the comparison with premortem clinical data.

The difference between injury scaling performed in the same patients on the basis of clinical information only and postmortem examination only is largely unknown. We compared scores in all 279 trauma patients who died in the Department of Critical Care Medicine at Auckland Hospital from 1982 through 1987 (93% blunt trauma, 4% penetrating trauma, 3% burns; median time until death--2 days) using both the 1980 and 1985 revisions of the Abbreviated Injury Scale (AIS-80, AIS-85) and derived Injury Severity Scores (ISS-80, ISS-85) where such scoring was based on clinical information only (CLAIS, CLISS) or postmortem findings only (PMAIS, PMISS). For the group as a whole, there was little difference in the distribution of scores between CLAIS and PMAIS or between CLISS and PMISS. However, CLISS-80 was different from PMISS-80 in 68% of individual patients. Most major differences between CLAIS and PMAIS (two AIS grades or more) occurred in the Head region, where injury scoring based on physiological features (e.g. coma) occurred without an anatomic injury of similar AIS grade, or in the Thorax region where therapy had either abolished the evidence of injury (e.g. pneumothorax) or injuries were discovered at postmortem examination which had not been appreciated clinically. Injury scaling data derived only from postmortem examination is not equivalent to that derived clinically. For maximum accuracy, postmortem data must be derived from an examination specifically guided by the needs of injury scaling and in full cognizance of injuries recognised and treated clinically.

Adult↗

Hyperspectral microarray scanning: impact on the accuracy and reliability of gene expression data.

BACKGROUND: Commercial microarray scanners and software cannot distinguish between spectrally overlapping emission sources, and hence cannot accurately identify or correct for emissions not originating from the labeled cDNA. We employed our hyperspectral microarray scanner coupled with multivariate data analysis algorithms that independently identify and quantitate emissions from all sources to investigate three artifacts that reduce the accuracy and reliability of microarray data: skew toward the green channel, dye separation, and variable background emissions. RESULTS: Here we demonstrate that several common microarray artifacts resulted from the presence of emission sources other than the labeled cDNA that can dramatically alter the accuracy and reliability of the array data. The microarrays utilized in this study were representative of a wide cross-section of the microarrays currently employed in genomic research. These findings reinforce the need for careful attention to detail to recognize and subsequently eliminate or quantify the presence of extraneous emissions in microarray images. CONCLUSION: Hyperspectral scanning together with multivariate analysis offers a unique and detailed understanding of the sources of microarray emissions after hybridization. This opportunity to simultaneously identify and quantitate contaminant and background emissions in microarrays markedly improves the reliability and accuracy of the data and permits a level of quality control of microarray emissions previously unachievable. Using these tools, we can not only quantify the extent and contribution of extraneous emission sources to the signal, but also determine the consequences of failing to account for them and gain the insight necessary to adjust preparation protocols to prevent such problems from occurring.

Algorithms↗