Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Data Sources”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources
PubMedDate not supplied

1992 Bonica Lecture. Advances in chronic pain management since gate control.

OBJECTIVE: Two pain treatment systems that developed soon after the publication of the gate theory are probably a direct result of its publication: neuraxial opiate administration and electrical stimulation of the spinal cord and peripheral nerves and receptors. Although the use of these modalities has become widespread in managing chronic pain, there is disagreement about their long-term efficacy. This presentation will attempt to review the data regarding the mechanisms of action of these modalities and their efficacy in treating chronic pain of malignant and nonmalignant origin. DATA SOURCES: Data were derived almost entirely from original articles reporting experimental data from both animal and human studies and from series of patients undergoing treatment with the modalities reviewed. STUDY SELECTION: Where possible, controlled studies were selected. However, much of the available data regarding treatment results are uncontrolled. DATA EXTRACTION AND SYNTHESIS: Selected data from studies that were felt to be reasonably well conducted are presented or summarized. Because of the lack of control groups in many of the clinical trials, meta-analyses were not carried out. CONCLUSIONS: Long-term spinal opiate administration has been shown to be more effective than systemic opiates in some patients with cancer pain, but often must be combined with local anesthetics to provide satisfactory pain relief. Loss of effect over time is a significant problem. Since the identification of spinal opiate receptors and the introduction of spinally administered narcotics, a number of other receptors that are important in both sensitization and suppression of pain projection systems have been characterized. Agonists and antagonists to many of these receptors are being developed, and a few are available for clinical trials. Long-term electrical stimulation of the spinal cord produces substantial analgesia below the stimulated spinal segments in some patients with chronic pain. Although initial results are usually encouraging, long-term efficacy may be disappointing. It is postulated that analgesia associated with spinal stimulation is associated with both stimulation of large fiber ascending tracts and blockade of spinothalamic pathways. Transcutaneous electrical nerve stimulation (TENS) has come into widespread use in managing chronic pain and has had limited trials in cancer pain patients. It is well accepted by patients and physicians, but clinical studies of long-term efficacy have yielded variable results. The analgesic action is probably the result of both large afferent fiber activation and blockade of peripheral nociceptors.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

New approaches: innovations in cancer prevention, diagnosis, treatment, and support.

PURPOSE/OBJECTIVE: To discuss and project changes in cancer care in the 21st century. DATA SOURCES: Projections are based on synthesis of multiple scholarly, professional, and governmental information sources. DATA SYNTHESIS: Changes will be reflected in the areas of patient subgrouping for more effective prevention and treatment; a redesigned therapeutic paradigm; a mind-body renaissance emphasizing holism and quality of life; and an accentuated influence of ethics on oncology nursing practice arising from healthcare reform and new scientific understanding of the human gene. CONCLUSIONS: Opportunities for nurses resulting from these changes include roles as genetic-risk analysts, health-education media designers, patient readiness evaluators, technology accessors, partners in a holistic care center, and treatment options advisors. IMPLICATIONS FOR NURSING PRACTICE: Nurses will need to respond to these challenges by expanding their knowledge base with respect to genetics and computer science, refining the interactive skills that are necessary to address the psychosocial aspects of cancer care, and assimilating new technology while designing strategies to minimize the dehumanizing consequences of technology dependency.

Delivery of Health Care↗
PubMed1993

A comparison of work-sampling and time-and-motion techniques for studies in health services research.

OBJECTIVE: This study compares results and illustrates trade-offs between work-sampling and time-and-motion methodologies. DATA SOURCES: Data are from time-and-motion measurements of a sample of medical residents in two large urban hospitals. STUDY DESIGN: The study contrasts the precision of work-sampling and time-and-motion techniques using data actually collected using the time-and-motion approach. That data set was used to generate a simulated set of work-sampling data points. DATA COLLECTION/EXTRACTION METHODS: Trained observers followed residents during their 24-hour day and recorded the start and end time of each activity performed by the resident. The activities were coded and then grouped into ten major categories. Work-sampling data were derived from the raw time-and-motion data for hourly, half-hourly, and quarter-hourly observations. PRINCIPAL FINDINGS: The actual time spent on different tasks as assessed by the time-and-motion analysis differed from the percent of time projected by work-sampling. The work-sampling results differed by 20 percent or more of the estimated value for eight of the ten activities. As expected, the standard deviation decreases as work-sampling observations become more frequent. CONCLUSIONS: Findings indicate that the work-sampling approach, as commonly employed, may not provide an acceptably precise approximation of the result that would be obtained by time-and-motion observations.

Bias↗
PubMed1993

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

OBJECTIVE: We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. DATA SOURCES: Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). STUDY DESIGN: A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. DATA COLLECTION: Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. PRINCIPAL FINDINGS: Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. CONCLUSIONS: Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

Analysis of Variance↗
PubMed1995

Trends in pediatric cardiac pacing.

OBJECTIVE: To review retrospectively a 31-year experience with pediatric cardiac pacing at the University of Toronto, with an emphasis on the changing trends in pacemaker implantation in infants and children. DATA SOURCE: Data were obtained from the pediatric pacemaker follow-up clinic at The Hospital for Sick Children, Toronto, Ontario or from the referring pediatric centre. Follow-up was normally continued until the death of the child or referral to an adult hospital at age 18 years. PATIENT SELECTION: The study comprised 397 children (under 18 years of age) who underwent initial pacemaker implantation at The Hospital for Sick Children between January 1962 and December 31, 1992. Follow-up was 99% complete (five children lost) and ranged from one month to 32 years (mean 6.5 years). DATA SYNTHESIS: The use of endocardial versus epicardial leads increased significantly over time (P < 0.001). In addition, significantly more children receiving pacemakers had sick sinus syndrome (P < 0.001). No difference in survival was found between children paced by endocardial versus epicardial leads or between children paced for sick sinus syndrome versus atrioventricular block. The frequency of exit block, by lifetable analysis, did not differ between children who received epicardial versus endocardial leads. CONCLUSIONS: Guidelines for permanent pacemaker implantation in children continue to evolve as developments in lead technology alter trends in pediatric cardiac pacing.

Adolescent↗
PubMed1996

Risk indicators for hospitalization during the last year of life.

OBJECTIVE: High levels of hospital expenditures for older people during their last year of life are widely documented. However, evidence of the association between prospectively measured indicators and subsequent hospitalization is sparse. This article investigates the pattern of hospitalization for a sample of Medicare enrollees during their last year of life. DATA SOURCES: Data from the Longitudinal Study of Aging, a national study of persons age 70 and older, are used. Only data on decedents are used. STUDY DESIGN: We determine individual characteristics (including functional status, evidence of disease, living arrangement, and prior hospitalization) shortly before the last year of life. A distinction is made between terminal and nonterminal admissions. National estimates and regression analyses using survey weights are conducted. PRINCIPAL FINDINGS: The likelihood of any use is high regardless of age, functional status, or the presence of major diseases. Although only a few indicators are associated with having a terminal stay, a number of indicators are associated with nonterminal use. Nonterminal stays and total nights hospitalized are positively associated with prior evidence of disease, prior hospitalization, and age, although the probability of nonterminal use decreases with age for persons over 82 years old. The relationship between use and functional status depends on whether persons lived alone, were institutionalized, or had private health insurance. CONCLUSIONS: This study demonstrates that while it is difficult to predict who will be admitted to the hospital at the time of death, a number of characteristics existing before the last year of life are associated with nonterminal hospitalization and total nights hospitalized during the last year of life.

Age Factors↗
PubMed1995

Epidemiology and control of tuberculosis in Israel.

OBJECTIVE: This review of the epidemiology and control of tuberculosis (TB) in Israel, covering the period from shortly before 1948 until the end of 1992 give a historical perspective to the TB situation and the various methods of control at different times. The effect of arrival in Israel of groups of immigrants from countries with a high prevalence of TB on the incidence in the host population is considered. DATA SOURCES: Data from unpublished reports and those published in Israel and abroad. Much data which was available form the Central TB Register of the Department of Epidemiology of the Ministry of Health was analyzed by the author during the time he was responsible for tuberculosis in Israel. Some of the data has been updated and presented here for the first time. RESULTS: With the mass immigration to Israel in the early 1950s, including many cases of active TB, there was a steep rise in the number of reported cases. Special services were developed. The TB rate dropped rapidly, and although there were later occasional peaks due to special immigrant groups, this did not appear to cause any serious increase in the TB incidence in the host population. CONCLUSIONS: TB control measures in Israel have passed through several phases and demonstrate the value of various methods which have to be changed according to the epidemiological situation.

Clinical Protocols↗
PubMed1997

Genetic and environmental contributions to healthcare need and utilization: a twin analysis.

OBJECTIVE: An exploratory study to examine the genetic and environmental influences on healthcare-seeking behavior for four health conditions (high blood pressure, mental health problems, joint disorders, and hearing problems). DATA SOURCES: Data collected from 3,602 male-male twin pair members of the Vietnam Era Twin (VET) Registry. STUDY DESIGN: Varying models for the relationship between genetic and environmental influences on health condition liability and on treatment use were tested in an attempt to explain the relative contributions of additive genetic, common, and unique environmental effects to health condition and treatment use. DATA COLLECTION: A mail and telephone survey of general health status was administered in 1987 to VET Registry twins. PRINCIPAL FINDINGS: Variance component estimates under the best-fitting model for the genetic component ranged from 24 percent to 52 percent for the condition status and from 42 percent to 56 percent for treatment-seeking behavior. CONCLUSIONS: Utilization models that consider only environmental parameters will leave a large percentage of variability unexplained. Familial patterns have an impact not only on disease susceptibility but also on healthcare utilization, thereby having lifelong implications for social and fiscal constraints placed on the healthcare system. Thus, explanatory models for healthcare utilization behavior should consider the contribution of genetic factors in the decision to seek and use health services.

Adult↗
PubMed1997

Drug patent expirations and the speed of generic entry.

OBJECTIVE: Using recent data, to analyze the generic drug entry phenomenon to determine the factors that influence the speed and likelihood of generic drug entries. DATA SOURCES: Data for 81 drugs that have lost patent between 1987 and 1994. Patent and exclusive marketing rights expiration dates: Food and Drug Administration's (FDA) Approved Drug Products with Therapeutic Equivalent Evaluations (1986-1989). Generic entry dates: FDA Drug and Device Product Approvals (Jan. 1987-Dec. 1994). Numbers of pending generic applications: FDA Office of Generic Drugs Quantitative Report-ANDAs and AADAs (Nov. 1990-Jan. 1993). Sales revenue: Pharmaceutical Data Services, Walsh-America. STUDY DESIGN: This study appropriately recognizes generic entry as a survival problem, and uses a proportional hazard method for analysis. PRINCIPAL FINDINGS: (1) There is a negative relationship between an innovative drug's sales revenue and the time to generic entry. (2) Entries of generics tend to be slower for drugs that have either very few or a very large number of competing brands in the marketplace. (3) The time to generic entry increased overall between 1987 and 1994. (4) Drugs that primarily treat chronic symptoms tend to enter faster than the types of drugs that primarily treat acute illnesses. CONCLUSIONS: The analysis shows that the generic industry is targeting large-revenue products and chronic drug markets. Entry of a generic drug is influenced by the existing branded substitutes in the marketplace. Surprisingly, the generic drug entry process has slowed despite many changes that would facilitate entry.

Drug Industry↗
PubMed1997

Alcohol and illicit drug abuse and the risk of violent death in the home.

CONTEXT: While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear. OBJECTIVE: To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs. DATA SOURCES: Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States. DESIGN: Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained. RESULTS: The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8). CONCLUSIONS: Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Adolescent↗
PubMed1998

Psychological distress and use of ambulatory medical services in the Quebec Medicare system.

OBJECTIVE: To document the impact of psychological distress symptoms on the use of ambulatory medical services in a universal insurance coverage context. DATA SOURCES: Data from the Quebec Health Survey (1987) linked with billing data from the Quebec Medicare system. The time frame for the utilization variables is one year before and one year after the QHS survey. STUDY DESIGN: LISREL was used to test a model introducing perceived health need as an explanatory factor of the relationship between psychological distress and the number of visits to a physician. Two samples were formed from the matched file. Sample A (n = 2,000) was used in an exploratory phase to adequately specify the model. Sample B (n = 2,000) was used to confirm the results obtained with Sample A. PRINCIPAL FINDINGS: The proposed model explained 35 percent of the number of visits to a physician in Sample A and 24 percent in Sample B. The effect of psychological distress symptoms on the respondent's perceived health need was as important as the effect of physical health status. The effect of the respondent's previous health services utilization on the number of visits to a physician was also significant. CONCLUSIONS: These results may be interpreted to indicate that in a universal insurance coverage context, psychological distress is a significant predictor of perceived health need.

Adolescent↗
PubMed1998

The effect of managed care on the incomes of primary care and specialty physicians.

OBJECTIVE: To determine the effects of managed care growth on the incomes of primary care and specialist physicians. DATA SOURCES: Data on physician income and managed care penetration from the American Medical Association, Socioeconomic Monitoring System (SMS) Surveys for 1985 and 1993. We use secondary data from the Area Resource File and U.S. Census publications to construct geographical socioeconomic control variables, and we examine data from the National Residency Matching Program. STUDY DESIGN: Two-stage least squares regressions are estimated to determine the effect of local managed care penetration on specialty-specific physician incomes, while controlling for factors associated with local variation in supply and demand and accounting for the potential endogeneity of managed care penetration. DATA COLLECTION: The SMS survey is an annual telephone survey conducted by the American Medical Association of approximately one percent of nonfederal, post-residency U.S. physicians. Response rates average 60-70 percent, and analysis is weighted to account for nonresponse bias. PRINCIPAL FINDINGS: The incomes of primary care physicians rose most rapidly in states with higher managed care growth, while the income growth of hospital-based specialists was negatively associated with managed care growth. Incomes of medical subspecialists were not significantly affected by managed care growth over this period. These findings are consistent with trends in postgraduate training choices of new physicians. CONCLUSIONS: Evidence is consistent with a relative increase in the demand for primary care physicians and a decline in the demand for some specialists under managed care. Market adjustments have important implications for health policy and physician workforce planning.

Age Distribution↗
PubMed1998

The role of uninsurance and race in healthcare utilization by rural minorities.

OBJECTIVE: To examine the independent effects of minority status, residence, insurance status, and income on physician utilization, controlling for general health status and the presence of acute or chronic health problems. Of special interest was the question of utilization differences among rural minority populations, as compared with urban non-Latino whites. DATA SOURCE: Data from the 1992 National Health Interview Survey (NHIS). STUDY DESIGN: Multivariate analyses used multiple logistic regression methods to detect independent effects of residence and minority status on whether or not individuals used physician services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from the National Health Interview Survey, 1992. The survey included information about the race/ethnicity of the respondent, health status, utilization of services, insurance status, and socioeconomic status. PRINCIPAL FINDINGS: The most salient determinant of utilization of healthcare services is insurance status, regardless of race/ethnicity or (rural or urban) place of residence. Racial and ethnic minorities were less likely than whites to use physician services, and use was generally lower for rural residents. The most striking differences were for rural Latinos and rural Asians/other persons. CONCLUSIONS: Although the results demonstrate a need to adjust policies designed to improve utilization by accounting for particular problems faced by minority populations, they also demonstrate the primacy of addressing financial access.

Adolescent↗
PubMedDate not supplied

Nursing informatics as a support function for oncology nursing research.

PURPOSE/OBJECTIVES: To provide an overview of nursing informatics and examples of informatics research highlighting the potential for intersecting such research with oncology nursing research. DATA SOURCES: Literature and online sources. DATA SYNTHESIS: Nursing informatics may be discussed from technical, theoretical, or clinical perspectives. The interface between nursing practice and nursing informatics provides an opportunity to create new science and research to expand the boundaries of nursing knowledge. CONCLUSIONS: It is time to evaluate the potential for intersecting informatics research with oncology nursing research. In an era of continuous healthcare change, nursing informatics has the potential to provide a unique contribution to oncology clinical practice and nursing research. IMPLICATIONS FOR NURSING PRACTICE: By creatively applying nursing informatics, oncology nurse researchers may better capture the phenomena relevant to oncology nursing practice and further the discipline.

Clinical Nursing Research↗
PubMed1999

Cracking the auditory genetic code: nonsyndromic hereditary hearing impairment.

OBJECTIVE: The application of molecular genetic techniques to the study of hereditary hearing impairment has contributed significantly to our understanding of the genetics of deafness. This article reviews the current state of our knowledge regarding the mapping and identification of genes associated with nonsyndromic hereditary hearing impairment. DATA SOURCES: Data were obtained from the medline database, the Molecular Biology of Deafness Meeting, and the Internet. STUDY SELECTION: Articles reporting information about the genetics of deafness were selected. DATA EXTRACTION: Data pertaining to auditory phenotype, location of genes, identification of genes, and implication for hearing were extracted. CONCLUSIONS: Significant progress has been made in understanding the molecular pathogenesis of deafness.

Chromosome Mapping↗
PubMed2001

Newspaper reports as a source for injury data in developing countries.

Injuries are an important public health problem and a leading cause of death among adults and children. In most of the developing world, with rapid changes in lifestyle, rural development, urbanization, an increase in number of vehicles, introduction of mechanized farming and pesticides in agriculture, the effect of injuries on mortality and morbidity is expected to increase. Injuries have been infrequently studied in developing countries; their importance is incompletely understood and they are seriously neglected in health research and policy. The reasons for this situation may be many, but one important reason is the unavailability of data in countries to assess the magnitude of the problem. Hospital and police records are the primary data source for injuries in the majority of the developing world. Newspaper reports may be an alternative source for injury data. This hypothesis was tested in the Rawalpindi Division of Pakistan by collecting data from newspaper reports for both intentional and unintentional injuries for 6 months (January-June 1999). This was compared with police data for the same time period. The results revealed that newspapers report more injury-related events and for some categories, such as suicides, the reporting was far greater by newspapers than the police. We conclude that the current system of police data collection needs to be strengthened. Newspapers may serve as a comparative source of information to evaluate the coverage of police data.

Bibliometrics↗
PubMed1996

Fatalities in the construction industry in the United States, 1992 and 1993.

To improve the estimates of occupational fatality rates for persons employed in the construction industry, several sources of data on the number of fatalities (the numerator) and the number of persons engaged in construction work (the denominator) were examined. Based on this examination, the Census of Fatal Occupational Injuries (CFOI), complied by the Bureau of Labor Statistics (BLS), was used to obtain numerators and the Current Population Survey, conducted by the Bureau of the census for the BLS, was used to obtain denominators. Adjustments were made in the numerator to include only occupations that were included in the denominator. Occupations were divided into two groups-those in the construction trades and those in other occupations within construction (e.g., clerical, sales). The analysis found fatality rates of 14.2 and 13.3 per 100,000 person-years, respectively, for 1992 and 1993, with wide variation in rates among the different trades. There were also major differences among the trades in the types of fatal injuries. Self-employed workers had much lower death rates overall than wage workers, but this is largely due to much lower proportions of high hazard trades among the self-employed. There have been wide variations in the occupational fatality rates reported for construction workers each year due to the differing methods of estimating the number of fatalities by the different data sources. This study provides a baseline of fatality rates using the best available current data. It compares the results from these data sources with those from other sources that have been used and discusses some of the problems inherent in the data from other sources. This study provides a significantly improved protocol for the calculation of fatality rates against which later rates can be compared consistently. Nevertheless, many deficiencies in the data sources used are identified. There remains ample room for continued improvement.

Accidents, Occupational↗
PubMed2001

Unsolicited narratives from the Internet: a rich source of qualitative data.

Recently, the Internet has become a forum for informal communication. Many--whose voices may have been unheard--can now express themselves through this medium. Rich narratives are available to the qualitative researcher from bulletin boards, guestbooks, Web pages, and listservs on the Internet. In this article, these data sources are defined and described. Strategies for using these data are discussed. One concern with using unsolicited data from the Internet is the protection of human subjects and the requirement for consent. A proposed model describing the process for deciding when such data are publicly available, as defined by the Office for the Protection of Rights of Research Subjects, and when the use of the data requires consent is presented.

Data Collection↗