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At least 811 records · Page 45Linked to original sources
PubMed2003

The living conditions of elderly Americans.

PURPOSE: This article profiles the housing settings of frail elderly individuals, whether their homes are facilitating or impeding their ability to live in the community, and the change in disability and housing status before and after passage of the 1990 Americans with Disabilities Act. DESIGN AND METHODS: The analysis relies primarily on statistical analysis of the 1995 national American Housing Survey (AHS), with supplementary analysis of the 1978 AHS. RESULTS: In 1995, roughly 14% of elderly individuals had a "housing-related disability," 49% had at least one dwelling modification, and 23% had an unmet need for modifications. Because half those with dwelling modification also reported unmet need, the match between disabling condition and modification, not the presence of modifications, is key. Multivariate results indicate that although unmet need is greater among the poor, lack of modifications is not. Prevalence of modifications nearly doubled between 1978 and 1995. Overall unmet need declined, but some needs were less likely to be met in 1995 than 1978. IMPLICATIONS: The analysis highlights the importance of information about housing for understanding the care and service needs of elderly individuals and provides a compelling argument for a minimum dataset on their housing and neighborhood environments.

Aged↗
PubMed2003

ALFRED: the ALelle FREquency Database. Update.

Elaboration of ALFRED (http://alfred.med.yale.edu) is being continued in two directions. One of which is developing tools for efficiently annotating the entries and checking the integrity of the data already in the database while the other is to increase the quantity and accessibility of data. Information contained in ALFRED such as, polymorphic sites, number of populations and frequency tables (one sample typed for one site) has significantly increased.

Alleles↗
PubMed2001

How can we keep private data private?

While technology increases the accessibility of patient data, it also compromises its confidentiality. Here, review the federal government's solutions.

Computer Security↗
PubMedDate not supplied

[The year 2003 National Registry of Home-based Parenteral Nutrition].

OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

Adolescent↗
PubMed1998

The Danish Medical Birth Registry.

BACKGROUND: The Danish Medical Birth Registry (MBR) was established in 1968 and has been computerized since 1973. The primary purpose of the registration is to monitor the health of the newborns and of the quality of the antenatal and delivery care services, but the registry is increasingly being used in research. Major changes in registration have taken place in 1978 and 1991. The paper describes the content and usage of the MBR over time and suggests research topics for the future. RESULTS: A broad scope of studies illustrates how the MBR has been used, either as single data source, linked with data from other registries or with data from interviews or self-completed questionnaires. Validations have shown variations in the quality of data, depending on source, and have underlined the need for constant quality control. Any access to data at the individual level is subjected to special provisions laid down by the Data Surveillance Authority and also requires a permission from the National Board of Health. CONCLUSIONS: The time from conception to early childhood is an important period concerning future health for the individual. The Danish Medical Birth Registry is a valuable tool in this respect, which has not yet been used to its full potential in research or monitoring. Experience indicates that the quality of the registry depends upon having a close link to the staff responsible for delivery services and thus having the necessary specialised skills and interest.

Data Interpretation, Statistical↗
PubMed2005

PoMaMo--a comprehensive database for potato genome data.

A database for potato genome data (PoMaMo, Potato Maps and More) was established. The database contains molecular maps of all twelve potato chromosomes with about 1000 mapped elements, sequence data, putative gene functions, results from BLAST analysis, SNP and InDel information from different diploid and tetraploid potato genotypes, publication references, links to other public databases like GenBank (http://www.ncbi.nlm.nih.gov/) or SGN (Solanaceae Genomics Network, http://www.sgn.cornell.edu/), etc. Flexible search and data visualization interfaces enable easy access to the data via internet (https://gabi.rzpd.de/PoMaMo.html). The Java servlet tool YAMB (Yet Another Map Browser) was designed to interactively display chromosomal maps. Maps can be zoomed in and out, and detailed information about mapped elements can be obtained by clicking on an element of interest. The GreenCards interface allows a text-based data search by marker-, sequence- or genotype name, by sequence accession number, gene function, BLAST Hit or publication reference. The PoMaMo database is a comprehensive database for different potato genome data, and to date the only database containing SNP and InDel data from diploid and tetraploid potato genotypes.

Chromosome Mapping↗
PubMed1997

Ultrasound-guided cannulation versus the landmark-guided technique for acute haemodialysis access.

BACKGROUND: The correct placement of large-bore venous catheters plays an important role in the management of haemodialysis patients. Whilst the procedure for landmark-based placement of these catheters is well known, the technique is not without significant morbidity and mortality. Complications include arterial puncture, haematoma, and pneumothorax. The procedure may be further complicated in these patients by venous thrombosis and abnormal vein position from multiple previous attempts at venous access. METHODS: Data on the use of ultrasound guidance versus anatomical landmarks for the placement of internal jugular vein (n = 69) and femoral vein (n = 30) dialysis access was retrospectively analysed over a 13-month period. Data collected included age, sex, duration on dialysis, number of vein cannulation sets required, number of attempts for successful cannulation, salvage of failed cannulation using landmark-based technique by ultrasound guidance, and the complication rate. RESULTS: Internal jugular vein cannulation using ultrasound was ultimately successful in 96.7% compared to 82% in the landmark group. The vein was entered on the first attempt in 83.3% of patients with ultrasound compared to 35.9% of the landmark group (P < 0.0001). Seven patients in whom the landmark technique was unsuccessful had access placed under ultrasound guidance. There were fewer carotid artery punctures in the ultrasound group (7.7 versus 0%, P = n.s.). In the femoral vein group, the vein was entered on the first attempt in 85.7% of patients with ultrasound compared to 56.25% of the landmark group (P = n.s.). CONCLUSIONS: The use of ultrasound guidance is associated with fewer complications and is more likely to lead to cannulation of the vein at the first attempt in haemodialysis patients.

Carotid Artery Injuries↗
PubMedDate not supplied

Access flow measurement during surveillance and percutaneous transluminal angioplasty intervention.

The introduction of routine access flow measurement methodology has enabled accurate identification of problematic accesses and provided a means for follow-up evaluation. These methods have uncovered, in some cases, that interventions are either immediately unsuccessful or that they fail within 3 months to maintain flow above preintervention levels. The purpose of this article is to analyze the main problems that occur at each step in the loop of flow surveillance-intervention-follow-up and to provide suggestions for improving outcomes. Analysis of published access flow data suggests that the main problems lie in the areas of inadequate analysis of flow surveillance data, lack of objective technology for quantifying intervention effectiveness, and lack of follow-up flow measurements in the hemodialysis (HD) unit after the intervention. The following three recommendations may improve surveillance outcomes: 1). using a reliable access flow technology combined with analysis of all hemodynamic data (including mean arterial pressure) before referring patients for angiography to decrease surveillance false positives; 2). performing intra-access blood flow measurement during angioplasty, which may improve outcomes by giving warning of errors before the patient leaves the intervention suite. Success achieved in restoring flow as measured during the intervention usually predicts good immediate outcomes in the HD unit; 3). measuring access flows during the next week after angioplasty. If the results are unsatisfactory, the patient should be further evaluated to avoid a potential thrombotic event.

Angioplasty, Balloon↗
PubMed1998

Implementation of a computerized cardiovascular information system in a private hospital setting.

BACKGROUND: The use of clinical databases improves quality of care, reduces operating costs, helps secure managed care contracts, and assists in clinical research. Because of the large physician input required to maintain these systems, private institutions have often found them difficult to implement. At LDS Hospital in Salt Lake City, Utah, we developed a cardiovascular information system (LDS-CIS) patterned after the Duke University Cardiovascular Database and designed for ease of use in a private hospital setting. METHODS: Features of the LDS-CIS include concise single-page report forms, a relational database engine that is easily queried, automatic generation of final procedure reports, and merging of all data with the hospital's existing information system. So far, data from more than 14,000 patients have been entered. RESULTS: LDS-CIS provides access to data for research to improve patient care. For example, by using data generated by LDS-CIS, the policy requiring surgical backup during percutaneous transluminal coronary angioplasty was eliminated, resulting in no increased patient risk while saving nearly $1 million in 1 year. LDS-CIS generates physician feedback reports documenting performance compared with peers. This physician self-evaluation has standardized and improved care. Information from LDS-CIS has been instrumental in securing and maintaining managed care contracts. LDS-CIS risk analysis provides physicians with outcomes data specific to their current patient's demographics and level of disease to assist in point of care decisions. CONCLUSION: The use of LDS-CIS in the routine operations of LDS Hospital heart services has been found to be feasible, beneficial, and cost-effective.

Cardiac Catheterization↗
PubMed1988

Reducing inpatient hospital costs: an attempt at Medicaid reform in Illinois.

While California's Medi-Cal program and Arizona's Health Care Cost Containment System have been subject to scholarly analysis, little has been written about a similar attempt at competitive bidding under Medicaid by Illinois. This article describes the process of implementing the Illinois Competitive Access and Reimbursement Equity (ICARE) program signed into law in 1984. The article examines hospital data and access implications for recipients and compares the Illinois program with other Medicaid contracting programs. A more thoughtful process of policy implementation is urged for such reform attempts in Medicaid.

Cost Control↗
PubMed1986

Overview of on-line information data bases in orthopedics.

For the last 20 to 25 years, American society has experienced exponential growth in the amount of medical information available. With the advent of computers and microcomputers, much of this information has been organized into on-line computer data bases accessible by health care practitioners. This article presents an overview of those on-line data bases that contain information of interest to the orthopedic health care professional.

MEDLARS↗
PubMedDate not supplied

[A model for monitoring drug prescribing in general practice].

When prescribing drugs, general practitioners at the same should satisfy the requirements of medical science and their vocation, being aware of their task of a rational disposal of the limited resources allocated for health care. The aim of the paper was to determine the characteristics of monitoring model for drug prescription in general practice, taking into consideration the characteristics of the population, morbidity, drugs and physicians. A prospective monitoring of prescribing drug during one month was carried out in six doctor's offices of general practice/family medicine at the Dugave-Travno Health Station of the Novi Zagreb Health Center. In processing data on patients, drugs and physicians the following were used: distribution description and analysis, pair's tests and General Factorial Anova. Out of 3397 patients who visited the above mentioned doctor's offices, 2320 (68.3%) patients were prescribed 4796 prescriptions--an average of 2.07 prescriptions per patient (from 2.00 to 2.42). The total cost of drug prescription was 360,117.33 kunas (from 43,632 to 77,910 kunas). The number of prescriptions and the cost of prescribed drugs increased significantly in terms of statistics with the age of patients (Spearman's correlation coefficient 0.2263; p < 0.001). By General Factorial Anova statistically significant difference was determined in the cost variable among the physicians with the impact of covariate age and number of prescriptions. Professionally, the most appropriate and most rational prescribing was observed among physicians who had the highest educational level and the longest experience in practice. In order to analyze and assess the appropriatness of drug prescription in general practice, the first essential step is to collect data on what is being prescribed, for whom it is being prescribed, and to enable access to data for physicians. This paper has indicated some of the characteristics of a monitoring model for drug prescription in general practice. Formulation and implementation of this model would considerably promote the professional appropriateness and rationality in drug prescription in general practice.

Adolescent↗
PubMed1998

[A remote access system for inquiry of centrally stored data on patients suspected of malignant hyperthermia . A prototypical development for the Internet].

OBJECTIVES: Malignant hyperthermia (MH) is an inherited, potentially life-threatening syndrome of the skeletal muscles. It is a life-threatening complication of anaesthesia with a high mortality (8-10%). The risk of the patient during anaesthesia due to an overlooked predisposition for MH can be reduced by organisational measures, such as, all data of MH-susceptible patients and their families known in Germany must be brought together in a central register, MH-relevant data of patients must be readily retrievable, optional oral advice for those making an inquiry must be available. METHODS: To achieve this goal, a client-server system has been implemented: Standard Multimedia personal computers installed at the user's (anaesthetist's) site, linked to the Internet, will act as clients. On a server, relevant data of patients concerning MH-susceptibility are integrated in a central database. The newly developed software of this project ensures the legally prescribed data security on the server and the data routes. At the client's site, standard software together with automatically installed programmes from the server using Java applets ensure easy use and maintenance. IMPLEMENTATION: The total system was implemented and tested. Its functionality and high availability was demonstrated during this test period. Relevant aspects of data security were successfully examined by the data security officer of the University Hospitals of Baden-Württemberg. The user can optionally call a multifunctional teleconference which secures on-line advice if needed. This system demonstrates a safe and quick retrieval of MH relevant data of patients via Internet while at the same time guaranteeing all aspects of data protection and security. CONCLUSION: A prototypical database access system is described. It ensures safe access to patient data via Internet, while guaranteeing all aspects of data security.

Computer Communication Networks↗
PubMed2002

Biological data integration: wrapping data and tools.

Nowadays scientific data is inevitably digital and stored in a wide variety of formats in heterogeneous systems. Scientists need to access an integrated view of remote or local heterogeneous data sources with advanced data accessing, analyzing, and visualization tools. Building a digital library for scientific data requires accessing and manipulating data extracted from flat files or databases, documents retrieved from the Web as well as data generated by software. We present an approach to wrapping web data sources, databases, flat files, or data generated by tools through a database view mechanism. Generally, a wrapper has two tasks: it first sends a query to the source to retrieve data and, second builds the expected output with respect to the virtual structure. Our wrappers are composed of a retrieval component based on an intermediate object view mechanism called search views mapping the source capabilities to attributes, and an eXtensible Markup Language (XML) engine, respectively, to perform these two tasks. The originality of the approach consists of: 1) a generic view mechanism to access seamlessly data sources with limited capabilities and 2) the ability to wrap data sources as well as the useful specific tools they may provide. Our approach has been developed and demonstrated as part of the multidatabase system supporting queries via uniform object protocol model (OPM) interfaces.

Algorithms↗
PubMed1996

How to approach the structuring of the medical record? Towards a model for flexible access to free text medical data.

The development and dissemination of Electronic Medical Records (EMR) is impeded because of several reasons. One of the reasons is considered the 'unruliness' of narrative data. In this article it is illustrated how the medical record can be structured to make it accessible from different perspectives, without the need to change the free text format of the narratives. The organising principles behind three existing medical record structures are analysed: the source-oriented, problem-oriented and time-oriented medical record. These principles are combined in a model of the medical record with four different views on medical data: a typological view, a time view, a problem view, and a process view. A data model is presented in which each of these views can be defined. In the discussion some examples are given of EMRs in which some of these views have been applied on coded data.

Data Display↗
PubMed2005

Scenario-based simulation of runoff-related pesticide entries into small streams on a landscape level.

The prediction of runoff-related pesticide entry into surface waters on a landscape level usually requires considerable efforts with regard to input data, time, and personnel. Therefore, the need for an easy to use simulation tool with easily accessible input data, for example from already existing public sources, is obvious. In this paper, we present a simulation tool for the simulation of pesticide entry from arable land into adjacent streams. Our aim was to develop a tool applicable on the landscape level using "real world data" from numerous sites and for the simulation of parameter case studies concerning particular parameters at single sites. We used the ratio of exposure to toxicity (REXTOX) model proposed by the OECD, which had been successfully validated in the study area as part of a previous study and which was extended to calculate pesticide concentrations in adjacent streams. We simulated the pesticide entry on the landscape level at 737 sites in small streams situated in the central lowland of Germany with winter wheat, barley, and sugar beat as the main agricultural crops. A sensitivity analysis indicated that the most significant model parameters were the width of the no-application zone and the degree of plant interception. The simulation was carried out for the 15 most frequently detected substances found in the study area using eight different environmental scenarios, covering variation of the width of the no-application zone, climate, and seasonal scenarios. The highest in-stream concentrations were predicted for a scenario using no (0m) buffer zone in conjunction with increased precipitation. According to the predicted concentrations, the risk for the aquatic communities was estimated based on standard toxicity tests and the application of a safety factor. The simulation results are presented both by means of risk maps for the study area showing the simulated pesticide concentration and the resulting ecological risk for numerous sites under varying scenarios and by case study diagrams with focus on the model behavior under the influence of single parameters. Risk maps confirmed the importance of no-application (buffer) zones for the levels of pesticide input. They also indicated the importance of the existing no-application zones for certain compounds and in some cases the need for a further evaluation of these regulations. The simulation tool was implemented as a standard PC software combining the REXTOX model with a geographical information system and can be used on any current personal computer. All input data was taken from public sources of German authorities. With little effort the tool should be applicable for other areas with similar data quality.

Computer Simulation↗
PubMed1990

Transplant information management system: a center-oriented approach to transplant data management.

TIMY is the ideal management system for novice data-entry personnel as well as for the research staff, nurses, and physicians at our facility. Access to data through the use of menus and security systems makes TIMY a user-friendly database. It has excellent data export capabilities so that more complex data analysis can be performed using dedicated software such as SPSS/PC, BMDP, or SAS. This provides great flexibility as well as the power needed for the study of complex data sets.

Database Management Systems↗
PubMed2006

Getting your game on with business data.

Data warehouses can virtually eliminate claims-related paper and fax transactions for hospitals. Data are accessible electronically, decreasing the need for staff to check on outstanding claims status requests by phone. Data warehouse technology can be used to create analytical reports and identify issues by dollar volume or procedure code. Providers can receive instant reports on both the "front end," as they are submitted, and on the "back end," when claims are denied.

Database Management Systems↗