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At least 865 records · Page 48Linked to original sources
PubMedDate not supplied

Analysis of electrical discharges made with the foramen ovale electrode recording technique in mesial temporal lobe epilepsy patients.

Foramen ovale electrode (FOE) implantation is usually indicated in patients with mesial temporal lobe (MTL) epilepsy. The authors conducted this study to characterize the electrical discharge patterns obtained using FOE recording and evaluated their clinical significance. Interictal and ictal discharge patterns and their temporal relationships to EEGs were examined in 16 patients who had FOEs implanted bilaterally and had good recovery from surgery. After long-term telemetry recording with FOEs, all patients displayed clear seizure onsets originating in one or both sides of the MTL and underwent an anterior temporal lobectomy. Interictal epileptiform discharges (IEDs) were lateralized to the operated side in 12 patients based on scalp EEGs and in 8 patients based on FOE recordings. Among the various possible IED patterns observed with the FOE recordings, a periodic pattern was dominant in the operated side (P = 0.001), whereas a polyspike pattern was dominant in the nonoperated side (P = 0.002). The number of patients with ictal onsets in the operated side was five based on the scalp EEG and 10 based on FOE recordings. Paroxysmal fast frequency activity, rhythmic spikes (>2 Hz), or sharp waves were dominant over other FOE seizure onset patterns in the operated side. By contrast, delta and theta slowing and positive spikes were prevalent in the nonoperated side. The start-stop-start pattern, previously described using subdural electrodes, was also found in FOE recordings and was concordant with the operated side in all cases. The interhemispheric propagation time recorded with bilateral FOEs was 22.6 +/- 20.0 seconds for ictal discharges initiated in the operated side and 7.0 +/- 8.4 seconds for those in the nonoperated side. Among various IED spreading patterns, the most prevalent progression was FOE --> contralateral FOE --> ipsilateral temporal lobe, or --> contralateral temporal lobe. In this series, FOE implantation caused no serious complications. FOE recording appears to be useful for confirming lateralization in patients with MTL epilepsy previously determined using clinical and neuroimaging methods. A thorough analysis of FOE recordings can provide information that may facilitate the differentiation of primary from secondary (nonepileptogenic) temporal lobes.

Adolescent↗
PubMed2006

Data sources for measuring comorbidity: a comparison of hospital records and medicare claims for cancer patients.

BACKGROUND: Identifying appropriate comorbidity data sources is a key consideration in health services and outcomes research. OBJECTIVE: Using cancer patients as an example, we compared comorbid conditions identified: 1) on the discharge facesheet versus full hospital medical record and 2) in the hospital record versus Medicare claims, both precancer diagnosis and associated with a cancer treatment-related index hospitalization. METHODS: We used data from 1995 Surveillance, Epidemiology and End Results patterns of care studies for 1,382 patients. Comorbid conditions were ascertained from the hospital record associated with the most definitive cancer treatment and Medicare claims. We calculated the prevalence for and assessed concordances among 12 conditions derived from the hospital record facesheet; full hospital record; Medicare claims precancer diagnosis, with and without a rule-out algorithm applied; and Medicare claims associated with an index hospitalization. RESULTS: The proportion of patients with one or more comorbid conditions varied by data source, from 21% for the facesheet to 85% for prediagnosis Medicare claims without the rule-out algorithm. Condition prevalences were substantially lower for the facesheet compared with the full hospital record. For prediagnosis Medicare claims, condition prevalences were more than 1.7 times greater in the absence of an algorithm to screen for rule-out diagnoses. Measures assessing concordance between the full hospital record and prediagnosis Medicare claims (rule-out algorithm applied) showed modest agreement. CONCLUSIONS: The hospital record and Medicare claims are complementary data sources for identifying comorbid conditions. Comorbidity is greatly underascertained when derived only from the facesheet of the hospital record. Investigators using Part B Medicare claims to measure comorbidity should remove conditions that are listed for purposes of generating bills but are not true comorbidities.

Aged↗
PubMed2004

Ceramic-based multisite electrode arrays for chronic single-neuron recording.

A method is described for the manufacture of a microelectrode array for chronic, multichannel, single neuron recording. The ceramic-based, multisite electrode array has four recording sites patterned onto a ceramic shaft the size of a single typical microwire electrode. The sites and connecting wires are applied to the ceramic substrate using a reverse photolithographic procedure. Recording sites (22 x 80 microm) are separated by 200 microm along the shaft. A layer of alumina insulation is applied over the whole array (exclusive of recording sites) by ion-beam assisted deposition. These arrays were capable of recording single neuron activity from each of their recording sites for at least three weeks during chronic implantation in the somatosensory cortex of rats, and several sites had recordings that lasted for more than 8 weeks. The vertical arrangement of the recording sites on these electrodes is ideal for simultaneously recording across the different layers of brain areas such as the cerebral cortex and hippocampus in chronic preparations.

Action Potentials↗
PubMed1979

Pre-P (Sino-atrial node region) activity recording from the right atrial cavity by signal averaging.

A mobile instrumentation and noninvasive method developed recently for external His bundle recording and employing the signal averaging technique was applied for intra-atrial recording of the pre-P (sino-atrial node region) activity. Recordings were obtained in ten anesthetized dogs and five patients at the time of right heart catheterization. A bipolar intra-atrial lead was used for triggering of the averaging process and a unipolar intra-atrial lead was used for signal recording. Direct bipolar epicardial recordings were obtained for comparison from the sino-atrial (S-A) node area in experimental animals. In animals studies, the averaged intra-atrial recording showed 30 muV amplitude deflections beginning 40-45 ms prior to the onset of P wave and were preceded by a slow rise and lower frequency and amplitude deflections arising 60-70 ms earlier. There was good correlation between the pre-P activity recorded intra-atrially and from the epicardium. Deflections of similar configuration but smaller amplitude (1 muV) were recorded in human studies. They preceded the onset of large atrial activity deflections (P wave) in the reference electrocardiogram by 40-80 ms. The exact source of these pre-P activity potentials has not been definitely established, but they appear to originate from the S-A node region, based on their similarity to the direct epicardial recordings and time relationship to the preceding T and following P wave.

Animals↗
PubMed1989

Localization of left free-wall and posteroseptal accessory atrioventricular pathways by direct recording of accessory pathway activation.

With the advent of catheter ablation techniques, precise localization of accessory AV pathways (AP) assumes greater importance. In an effort to define the course of AP fibers, we attempted to record activation of 56 left free-wall and 23 posteroseptal APs in 62 patients undergoing electrophysiological study. The coronary sinus (CS) and great cardiac vein (GCV) were mapped using orthogonal catheter electrodes, which provide a recording dipole perpendicular to the AV groove. The tricuspid annulus (TA) was mapped using a 2 mm spaced octapolar electrode catheter. Potentials were considered to represent AP activation only if they could be dissociated from both atrial and ventricular activation by programmed stimulation. Orthogonal catheter electrodes in the CS and GCV were advanced beyond the site of earliest retrograde atrial activation and/or earliest antegrade ventricular activation in 45 of the 56 left free-wall APs, and AP potentials were recorded from 42 (93%). An oblique course was identified in 36 APs, with the ventricular insertion being recorded 4-30 mm (median 15 mm) distal or anterior to the atrial insertion. In three patients, antegrade and retrograde conduction proceeded over different (but close) parallel fibers. AP potentials were recorded from 19 of 23 posteroseptal pathways. Ten pathways (left posteroseptal) were recorded from the CS, beginning 5-11 mm (median 9 mm) distal to the os, with potentials extending 8-18 mm (median 11 mm) distally. Four pathways (mid-septal) were recorded along the TA, anterior to the CS ostium and posterior to the His bundle catheter. Five pathways (right posteroseptal) were recorded along the TA, directly opposite or immediately posterior to the CS ostium. One of the patients had both midseptal and left posteroseptal pathways and three patients had both right posteroseptal and left posteroseptal pathways. We conclude: 1) left free-wall APs transit the AV groove obliquely and may be comprised of multiple, closely spaced, parallel fibers; 2) the anatomical location of "posteroseptal" pathways is variable and the presence of fibers at multiple sites is common; and 3) direct recordings of AP activation facilitate tracking of the accessory pathway along its course from atrium to ventricle and help identify the presence of multiple fibers.

Action Potentials↗
PubMed1994

Bridging the gap between basic and clinical electrophysiology: what can be learned from monophasic action potential recordings?

With rapid advances occurring in both basic and clinical electrophysiology, the gap between the two disciplines appears to be widening rather than narrowing. In most instances, we cannot apply the knowledge derived from cellular studies directly to clinical practice. Monophasic action potential (MAP) recording by contact electrode technique allows us to measure basic electrophysiological phenomena in the human heart and thus provides an important bridge between basic and clinical electrophysiology. MAP recordings produce the time course of cellular repolarization during cycle length changes and antiarrhythmic drug administration, lending insights into use dependency and reverse use dependency of antiarrhythmic drug effects in the clinical electrophysiology laboratory. The ability to deliver electrical stimuli at the MAP recording site further allows one to investigate drug-induced postrepolarization refractoriness. MAP recordings provide precise local activation times, important for mapping of abnormal ventricular activation, and detect areas of abnormal repolarization due to ischemia or scarring. MAP recordings are uniquely suited to detect early and delayed afterdepolarizations in the human heart, thereby helping to unravel the arrhythmia mechanisms in the long QT syndrome. By embedding the MAP electrode in a radiofrequency electrode, arrhythmogenic foci may be both detected and ablated. In many instances, MAP recordings are more accurate than ECG tracings in defining and distinguishing ventricular fibrillation and ventricular tachycardia. This can be of clinical importance during testing of the implantable cardioverter/defibrillator. An area of growing interest is stretch-activated arrhythmias. Here, MAP recordings are of particular value because no other method is available to record mechanically induced electrophysiological changes in the vigorously beating heart. It can be expected that MAP recordings will, in the future, provide this important bridge between "cell and bedside" also in atrial tachyarrhythmias, such as in atrial fibrillation and flutter.

Action Potentials↗
PubMed1990

Maturation of the cutaneomuscular reflex recorded from the first dorsal interosseous muscle in man.

1. Cutaneous reflexes have been recorded from the first dorsal interosseous muscle following electrical stimulation of the digital nerves of the index finger in man. Recordings have been obtained from 127 children, aged from 3 to 18 years while each performed an isometric abduction of the index finger and whole hand grips. 2. In the adult, reflexes recorded while subjects performed an isometric abduction of the index finger consisted of three readily identifiable components within the first 100 ms. These were an initial short spinal latency increase in EMG (E1), followed by a decrease (I1), followed by a prominent longer-latency increase (E2) which was normally larger in size than the shorter-latency increase. 3. The configuration of the reflex changed during development. When recorded during an abduction, the E1 component was present in all children and showed a small but progressive reduction in size with age. With increasing age, both the I1 and E2 components were present in an increasing proportion of children and increased in size until the adult configuration was reached at 14-15 years. 4. Comparison of reflexes recorded during sustained whole hand grips with reflexes recorded during an isometric index finger abduction revealed differences in all three components. When recorded during those grips used in the present study the E1 component was generally significantly larger while the I1 component was generally significantly smaller than when recorded during index finger abduction. At all ages the E2 component was significantly smaller when recorded during a grip. 5. The configuration of the reflex during an isometric index finger abduction was compared with the ability of the child to perform rapid finger movements. Those children who had no E2 component tended not to perform well in the tests of rapid finger movement. However, there was no simple relationship between the size of the E2 component and ability to produce rapid finger movements.

Adolescent↗
PubMed2002

Empirical refinements applicable to the recording of fish sounds in small tanks.

Many underwater bioacoustical recording experiments (e.g., fish sound production during courtship or agonistic encounters) are usually conducted in a controlled laboratory environment of small-sized tanks. The effects of reverberation, resonance, and tank size on the characteristics of sound recorded inside small tanks have never been fully addressed, although these factors are known to influence the recordings. In this work, 5-cycle tone bursts of 1-kHz sound were used as a test signal to investigate the sound recorded in a 170-l rectangular glass tank at various depths and distances from a transducer. The dominant frequency, sound-pressure level, and power spectrum recorded in small tanks were significantly distorted compared to the original tone bursts. Due to resonance, the dominant frequency varied with water depth, and power spectrum level of the projected frequency decreased exponentially with increased distance between the hydrophone and the sound source; however, the resonant component was nearly uniform throughout the tank. Based on the empirical findings and theoretical calculation, a working protocol is presented that minimizes distortion in fish sound recordings in small tanks. To validate this approach, sounds produced by the croaking gourami (Trichopsis vittata) during staged agonistic encounters were recorded according to the proposed protocol in an 1800-l circular tank and in a 37-l rectangular tank to compare differences in acoustic characteristics associated with tank size and recording position. The findings underscore pitfalls associated with recording fish sounds in small tanks. Herein, an empirical solution to correct these distortions is provided.

Acoustics↗
PubMed1996

Onboard acoustic recording from diving northern elephant seals.

This study was the first phase in a long-term investigation of the importance of low-frequency sound in the aquatic life of northern elephant seals, Mirounga angustirostris. By attaching acoustic recording packages to the backs of six translocated juveniles, the aim was to determine the predominant frequencies and sound levels impinging on them, and whether they actively vocalize underwater on their return to their rookery at Ano Nuevo, California, from deep water in Monterey Bay. All packages contained a Sony digital audio tape recorder encased in an aluminum housing with an external hydrophone. Flow noise was minimized by potting the hydrophone in resin to the housing and orienting it posteriorly. The diving pattern of four seals was recorded with a separate time-depth recorder or a time-depth-velocity recorder. Good acoustic records were obtained from three seals. Flow noise was positively correlated with swim speed, but not so high as to mask most low-frequency sounds in the environment. Dominant frequencies of noise impinging on the seals were in the range 20-200 Hz. Transient signals recorded from the seals included snapping shrimp, cetacean vocalizations. boat noise, small explosive charges, and seal swim strokes, but no seal vocalizations were detected. During quiet intervals at the surface between dives, the acoustic record was dominated by respiration and signals that appeared to be heartbeats. This study demonstrates the feasibility of recording sounds from instruments attached to free-ranging seals, and in doing so, studying their behavioral and physiological response to fluctuations in ambient sounds.

Acoustics↗
PubMed1998

Painful stimuli evoke potentials recorded from the parasylvian cortex in humans.

Cutaneous stimulation of the face and hand with a CO2 laser in three awake patients evoked potentials (LEPs) recorded from the dominant left parasylvian cortex. These were recorded by means of a subdural grid of electrodes implanted for evaluation of epilepsy. Stimulation of the contralateral face resulted in waveforms consisting of a negative potential (N2, 162 +/- 5 ms; mean +/- SE) followed by a positive potential (P2, 340 +/- 18 ms). Both waves occurred at longer latency after hand than after facial stimulation. N2 and P2 potentials recorded from the grid correspond well in morphology to those recorded from the scalp in four additional patients tested with the same stimulation paradigm. The N2 waves recorded from the subdural grid occurred at significantly shorter latencies than did those recorded from the scalp (184 +/- 6 ms), but the P2 waves at the grid occurred at significantly longer latencies than did those recorded at the scalp (281 +/- 13 ms). The amplitudes of the potentials recorded from the grid were maximal over the parietal operculum both for contralateral stimulation of the face or hand and for ipsilateral stimulation of the face. Potentials also were recorded in this area after stimulation of the ipsilateral hand. The cortical distributions of these potentials suggest that their generators are located in the parietal operculum or in the insula, or in both, consistent with previous PET, magnetoencephalographic, and scalp LEP source analyses. These previous analyses provide indirect evidence of nociceptive input to parasylvian cortex because the interpretation of each analysis incorporates multiple assumptions. The present results are the first direct evidence of nociceptive input to the human parasylvian cortex.

Adult↗
PubMed1992

Mechanism of double potentials recorded during sustained atrial flutter in the canine right atrial crush-injury model.

BACKGROUND: During atrial flutter, double potentials may be recorded at specific sites in the atria. It has been suggested that double potentials represent sequential activations at the center of the reentrant circuit. An alternative hypothesis is that double potentials represent electrical activity in an area of slow conduction. Understanding their mechanism is important because double potentials have been considered a possible indicator of target sites for catheter ablation. METHODS AND RESULTS: We systematically studied double potentials in our canine model of atrial flutter produced by right atrial crush injury using a 64-channel computerized mapping system with 56 electrodes on the right atrium in seven mongrel dogs under general anesthesia. Activation maps were recorded during sinus rhythm before and after crush injury, during rapid pacing above and below the crush injury, and during sustained atrial flutter, entrainment of atrial flutter, and termination of atrial flutter induced with D-sotalol (2 mg/kg). During sinus rhythm before crush injury, activation was uniform, and double potentials were not recorded in any dog. After crush injury, activation proceeded up to and around the crush injury, and narrowly split double potentials were recorded in two of seven dogs. During rapid pacing above and below the crush injury, double potentials were recorded in five dogs. During 14 episodes of atrial flutter (mean cycle length, 140 +/- 16 msec), double potentials were recorded at electrodes along the crush injury. The activation time of the early x component of the double potentials (25 +/- 13 msec) was similar to that of adjacent electrodes above the crush injury (24 +/- 11 msec), and the activation time of the late y component (89 +/- 13 msec) was similar to that of adjacent electrodes below the crush injury (91 +/- 14 msec). The timing of the x and y components was dependent on the location of the recording electrode, with x and y widely spaced at the end of the crush injury near the area of earliest atrial activation during atrial flutter, more equally timed at the center of the crush injury, and more closely timed at the end of the crush injury opposite the area of earliest activation. During transient entrainment, double potentials were accelerated to the pacing rate, but their activation time relative to adjacent electrodes was maintained. During abrupt termination of atrial flutter, the early x component of the double potential was always recorded, but the late y component was not, because of conduction block below the posterior end of the crush injury. CONCLUSIONS: This study has shown in our canine model of atrial flutter that double potentials are recorded from the center of the reentrant circuit and that they represent sequential activations as the reentrant wave front passes on either side of the crush injury.

Action Potentials↗
PubMed1999

A new type of microelectrode for obtaining unitary recordings in the human spinal cord.

OBJECT: In this paper the authors report on the conception and adjustment of a microelectrode used to obtain unitary recordings in the human spinal cord. METHOD: To overcome the difficulties related to intraoperative pulsations of the spinal cord, the authors opted to use a floating microelectrode. Because the recordings are obtained most often from spontaneous activities, it is difficult, with a single microelectrode, to separate spikes from electrical artifacts that are related to the switching of devices. Consequently, the authors designed a dual microelectrode made of two tungsten-in-glass-attached microelectrodes separated by 300 microm. Because the two electrodes cannot obtain recordings in the same neuron, it is possible to distinguish unambiguously spikes (recorded on one tip) from electrical artifacts (recorded simultaneously on the two tips). The dual microelectrode is 2 cm long, with a 20-microm tip length, and 800 to 1200-Ohms impedance. This microelectrode can be implanted "free hand," in the dorsal horn, by using a microsurgical forceps under a surgical microscope. The data analysis is performed off-line with spike sorter hardware. In the dorsal horns in 17 patients who were selected to undergo a dorsal root entry zone (DREZ) rhizotomy to treat various pathological conditions, unitary recordings were obtained using this double microelectrode. The authors recorded 57 neurons in good conditions of stability and isolation. CONCLUSIONS: The microelectrode described in this paper was successfully used to obtain recordings in neurons in more than 85% of the patients. This simplified, floating double microelectrode can therefore be considered for use in microsurgical DREZ rhizotomy to obtain unitary recordings in the human spinal dorsal horn.

Artifacts↗
PubMedDate not supplied

Comparison of human triceps surae H-reflexes obtained from mid and distal recording sites.

The purpose of this study was to determine whether a distal triceps surae recording site produced H-reflex responses similar to those obtained from the conventional soleus location in 10 healthy subjects at rest. H-reflex and M-response recruitment profiles were generated and the peak-to-peak amplitudes were measured from the two sites simultaneously. Following this, an H-reflex control signal was determined (peak-to-peak amplitude approximately equal to 30% Mmax) and 4 series of 10 trials were recorded at 5 minute intervals. A paired t-test showed non-significant (p greater than 0.05) differences in Hmax, Mmax, and Hmax: Mmax values recorded from the two sites. Linear regression analyses of recruitment profile H-reflexes and M-responses, obtained simultaneously from the two recording sites showed strong correlations (r greater than 0.90, p less than 0.001). To assess the stability of the reflex over time, intraclass correlation coefficients (ICC) were computed for each recording site (R = 0.99 in both instances). Thus the distal recording site, just proximal to the flare of the medial malleolus, is an acceptable alternative to the conventional recording location. This permits recording H-reflex amplitude changes, resulting from the application of a therapeutic intervention to the calf muscles, without having to remove and reposition the recording electrodes.

Adult↗
PubMed1987

Evaluation of a Holter system to record ST-segment changes.

This study was performed to establish the accuracy of the Avionics 445B recorder and Innovator 750 scanner for identifying ST-segment changes in patients undergoing treadmill exercise testing. A series of 143 patients underwent treadmill exercise testing with 12-lead ECG monitoring and 2-lead Holter monitoring. The mean age of the patients (134 men and 9 women) was 59.3 years (range, 27 to 77). The frequency range of the recorder was 0.08 to 30 Hz. A modified V2 and V5 bipolar lead system was used for the Holter recording. The Holter tape was then scanned using the Innovator 750 scanner. The technician adjusted the baseline-reference point and J-point and then did not interact further with the recording. Treadmill exercise testing was undertaken using a submaximal Bruce protocol with 12 standard ECG leads recorded. Forty-two patients had positive ST-segment changes recorded by both the 12-lead ECG and the Holter monitor. Ninety-two patients had no ST-segment changes recorded by either of the systems. With the 12-lead ECG recorded during the treadmill exercise test used as the standard, the sensitivity of the Holter system was 89%, specificity 96%, and positive predictive accuracy 91%. The Holter recorder and automated scanning system should reliably detect episodes of ST-segment change occurring during ambulatory ECG monitoring.

Coronary Disease↗
PubMed1993

[The effect of surface area of active recording electrode to CMAP parameters].

The purpose of this study is to quantitatively evaluate the effect of surface area of active recording electrodes to CMAP. The APB muscles from 19 young healthy subjects were included. The evoked CMAPs from median nerve supramaximal stimulation at wrist were recorded with regular surface disc electrode. Then the active recording electrode were changed to 1/2 surface area of disc, 1/4 surface area of disc, monopolar needle and concentric needle at the same recording sites. Computer reading of the latency, duration, amplitude and surface area of the CMAP were done and compared to that of standard electrode. Results disclosed that decrease the surface area of active recording did not significantly influence the distal latency, duration, amplitude and surface area of the CMAP (p > 0.1), although tendency to increase the amplitude and area were noted. The recording abilities of the active recording and the surface area difference between active recording and reference were considered to be the contributing factors. In clinical application such as recording an area with skin defect, the surface area of active recordling electrode can be altered without significant distortion of CMAP parameters.

Action Potentials↗
PubMed1994

On the design of anaesthesia record forms.

The purpose of this report is to develop a rational approach to the design of anaesthesia record forms. The history of anaesthesia record forms was reviewed. A logical approach to the design of an anaesthesia record was developed. The theoretical ideal anaesthetic record was contemplated and criteria were developed for the selection of items to be included in or excluded from the record. Principles were outlined which lead to logical organization of information on the form, improved ergonomics of data entry, and ready access to entered information. A desktop publishing system was used to execute quickly numerous form artwork revision cycles and iteratively converge on a complete design. This approach has resulted in the development and production of a new anaesthesia record for our institution. The record was well accepted by our colleagues. The rationale that has been developed is presented in the hope that it will be useful to others in the process of designing anaesthesia records for their institutions.

Anesthesia↗
PubMed2001

Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: a potential tool for evaluation of emergency medical services.

STUDY OBJECTIVES: Emergency medical services (EMS) is an important part of the health care system. The effect of EMS on morbidity, mortality, and costs of illness is difficult to evaluate because hospital information is not available in out-of-hospital databases. We used probabilistic linkage to create such a database from ambulance and inpatient data and demonstrate the potential for linkage to facilitate evaluation of EMS responses resulting in hospital admission. METHODS: Statewide ambulance and inpatient hospital discharge records were available for 1994 through 1996. Ambulance records indicating admission to the emergency department or hospital (165,649 records) were linked to inpatient hospital records indicating emergency admission (146,292 records) by using probabilistic linkage. Out-of-hospital data (dispatch code, treatments rendered, and ages), linkage rates, and inpatient data (discharge status, charges, length of stay, and payer category) were analyzed. RESULTS: We linked 24,299 (14.7%) ambulance events to inpatient hospital discharges. If we had used exact linkage methods, we would have only linked 14,621 record pairs, a loss of nearly 40%. Linkage rates were relatively constant between years (approximately 15%) but differed by ambulance dispatch codes. Out-of-hospital dispatch codes with high linkage rates included breathing problems (22.6%), chest pain (21.5%), diabetic problems (16.9%), drowning incidents (14.9%), falls (19.2%), strokes (32.8%), and unconsciousness or fainting episodes (16.1%). Linkage to the hospital record provided access to hospital outcome data. Inpatient mortality was 6.8%. Survivors were discharged home (60.7%), transferred to other acute-care facilities (3.6%) or intermediate-care facilities (23.3%), or discharged with home health care provision (4.9%). The median length of stay was 3 days, and median charges were $6,620; total inpatient charges were $286,737,067. CONCLUSION: Probabilistic linkage enables ambulance and hospital discharge records to be linked together and potentially increases our ability to critically evaluate EMS by providing access to hospital-based outcomes. Such evaluation will be further improved by linking to ED, other outpatient, and other public health data sources.

Adolescent↗
PubMed1992

General practitioner records on computer--handle with care.

This 1 year prospective study involved nine general practitioners in an urban health centre who routinely record all patient contacts on computer. The study determines by comparison with a manual record how accurately doctors record laboratory investigations on computer and compares the effectiveness of three interventions in improving the completeness of computerized recording of presenting symptoms, problems/diagnoses and laboratory investigations. Recording was analysed for 1 month prior to and for two 1 month periods following each intervention. A control group was used. A total of 7983 patient contacts were analysed. Intervention led to an improvement in the recording of presenting symptoms and problems/diagnoses. Recording of investigations on the computer showed no improvement, remaining at one-third of the total in the treatment room book for both study and control doctors. The effectiveness of the different forms of intervention depended on both the aspect of the consultation considered and the familiarity of individual doctors with the method of data collection. Aspects considered less important required greater intervention to bring about a marked improvement, as did doctors relatively new to the practice. It may not be possible to get all aspects of the consultation recorded with the same degree of accuracy. This has implications for the accuracy of retrospective studies dependent on existing computerized data.

Family Practice↗