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PubMed1992

The use of the medical record and financial data to examine the cost of infections in the elderly.

This study demonstrates what can be accomplished when the medical record and other data sources are utilized. By using the medical record as well as financial data and input from the infectious disease department, a detailed analysis of infections in an elderly population in relation to cost and length of stay was completed. This pilot study also enabled the hospital to determine the types of studies that should be done in the future. Quality assessment and improvement studies that examine the effectiveness of infection control procedures over time, the importance of examining both community-acquired and nosocomial infections, and the differences that severity of illness may have on cost and length of stay are all areas that have been identified as needing further study. Future studies in this area and other areas will continue to utilize the medical record. However, the data obtained from the medical record should not be examined alone. It should be analyzed along with other data sources such as severity of illness data, financial data, quality assessment data, infection control data, and risk management data in order to examine epidemiological trends over time. Only when several data sources are used together to investigate a particular aspect of care will that aspect of care be thoroughly and completely examined.

Aged↗

PubMed2001

CT colonography: data acquisition and patient preparation techniques.

The success of a virtual endoscopy is essentially dependent on the image quality of the corresponding 3-dimensional reconstructions. Before loading image data on a post-processing computer, certain prerequisites concerning the source data must be met. To carry out a CT colonography, the source data must be of good quality. High spatial resolution in all geometrical directions, continuous data acquisition without gaps, and artefact-free images are pivotal factors influencing source data. A generally applicable rule is that the size of the smallest detectable polyp is limited by the nominal slice thickness, emphasizing the ultimate importance of the initially chosen primary slice collimation. Furthermore, calculation of an endoluminal view is impossible without sufficient distension of the bowels. Thorough patient preparation that accommodates the technical circumstances for post-processing is also required for attaining a high sensitivity in polyp detection.

Cathartics↗

PubMed2006

Lapatinib: a novel dual tyrosine kinase inhibitor with activity in solid tumors.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trials, adverse effects, and drug interactions of lapatinib. DATA SOURCES: A PubMed search was conducted (1966-August 2005) using the following terms: lapatinib, GW572016, and dual tyrosine kinase inhibitor. Additional information sources included meeting abstracts, clinical trial data, and bibliographies from articles identified through PubMed. STUDY SELECTION AND DATA EXTRACTION: Preclinical and clinical trials that evaluated lapatinib in cell culture, animal models, and human subjects were selected from the data sources. Pivotal in vitro data and all in vivo data published regarding lapatinib were included. DATA SYNTHESIS: The development of tyrosine kinase inhibitors has resulted from a search for targeted cancer therapeutics made possible by recent gains in our understanding of tumor cell biology. Lapatinib is a dual tyrosine kinase inhibitor selective for inhibition of epidermal growth factor receptor and human epidermal growth factor receptor-2 autophosphorylation, leading to suppression of proliferation pathways of solid tumors. Lapatinib has shown clinical activity in solid tumors, with the most notable in advanced or metastatic breast cancer, including tumors refractory to trastuzumab. It has a mild adverse effect profile, with the most common adverse events being diarrhea and rash. CONCLUSIONS: Lapatinib has novel, dual tyrosine kinase inhibitory properties selective for factors overexpressed in some solid tumors. Results from preclinical and Phase I/II trials indicate activity in the treatment of solid tumors, especially advanced or metastatic breast cancer. Application for approval is anticipated pending results of ongoing Phase III trials.

Animals↗

PubMed2006

Comparison of administrative data and medical records to measure the quality of medical care provided to vulnerable older patients.

BACKGROUND: Administrative data are used to determine performance for publicly reported in health plan "report cards," accreditation status, and reimbursement. However, it is unclear how performance based on administrative data and medical records compare. METHODS: We compared applicability, eligibility, and performance on 182 measures of health care quality using medical records and administrative data during a 13-month period for a random sample of 399 vulnerable older patients enrolled in managed care. RESULTS: Of 182 quality indicators (QIs) spanning 22 conditions, 145 (80%) were applicable only to medical records and 37 (20%) to either medical records or administrative data. Among 48 QIs specific to geriatric conditions, all were applicable to medical records; 2 of these also were applicable to administrative data. Eligibility for the 37 QIs that were applicable to both medical records and administrative data was similar for both data sources (94% agreement, kappa = 0.74). With the use of medical records, 152 of the 182 the QIs that were applicable to medical records were triggered and yielded an overall performance of 55%. Using administrative data, 30 of the 37 QIs that were applicable to administrative data were triggered and yielded overall performance of 83% (P < 0.05 vs. medical records). Restricting to QIs applicable to both data sources, overall performance was 84% and 83% (P = 0.21) for medical records and administrative data, respectively. CONCLUSIONS: The number and spectrum of QIs that can be measured for vulnerable elderly patients is far greater for medical records than for administrative data. Although summary estimates of health care quality derived from administrative data and medical records do not differ when using identical measures, summary scores from these data sources vary substantially when the totality of care that can be measured by each data source is measured.

Aged↗

PubMedDate not supplied

Uses of data to plan cancer prevention and control programs.

Seven State health departments, those in Illinois, Nebraska, New Jersey, New York, North Carolina, Texas, and Wisconsin, have participated in an effort to utilize a variety of State-specific cancer-related data to describe the cancer burden in their State's population. The data were then used to develop a statewide cancer plan or supplement an existing plan to address the defined problems. Cancer data have not been well utilized in the planning of intervention programs in the past, and the efforts in these States can serve as models for data use in programs to prevent and control cancer and other chronic diseases. State-specific data can be used to rank needs and make a clear case that can influence decision makers regarding resource allocation. The purpose of this report is to describe the data sources and additional statistics that were used to provide a broad picture of the cancer burden that will aid in targeting and defining intervention needs. Mortality, incidence, risk factor prevalence, and hospital discharge data appear to be the most accessible and potentially useful of the data sources examined, whereas insurance claims data, sources of treatment data, and environmental data bases were less useful in planning intervention strategies.

Data Collection↗

PubMed2000

Use of routine healthcare data in safe and cost-effective drug use.

Routine healthcare data is becoming widely available, usually as a result of administrative systems. Other related data are also often available, such as biochemistry results, mortality data, and sometimes prescribing data. These records are often linked via a common identification system or by probability matching techniques. These data sources offer many opportunities to undertake research, and where prescription data are recorded and linked, the facility to research the outcome of drug use often exists. There are now a number of research agencies around the world that use these large routine data sources to undertake drug safety and outcome studies. The purpose of this commentary is to describe some of the history behind the development of these systems, illustrate some of their uses with respect to postmarketing drug safety and to other healthcare research objectives. The review then describes the data sources necessary to develop a system that would offer an optimal system to undertake a range of studies, including population drug safety surveillance. There are both positive and negative considerations when using routine data. On the positive side, these data come from 'real life' experiences and not from the clinical trial situation. On the other hand, there are important biases to be aware of such as confounding by indication. On the whole, it is argued that large databases originating from routine healthcare procedures have an important role to play in the cost-effective prescription drug use in the postmarketing setting. These systems cannot replace other methods of drug safety evaluation but they do offer an important adjunct to spontaneous reporting systems.

Drug Monitoring↗

PubMed1996

An increased incidence of total anomalous pulmonary venous drainage among aboriginal Canadians.

OBJECTIVE: To determine whether Aboriginal Canadians from Manitoba and Ontario have an increased incidence of isolated total anomalous pulmonary venous drainage (TAPVD) and to compare results obtained from two different data sources and time periods. DESIGN: A nonconcurrent cohort study was undertaken. Incidence rates and relative risk from 'traditional' data sources (cases from medical records data; births from Census, Vital Statistics and Native Registry data for Manitoba and Ontario) from 1972-84 were derived and compared with those from computerized hospital abstract data from Manitoba for 1987-91. RESULTS: Using traditional data sources an incidence of 0.282/1000 live births was noted in Aboriginals versus 0.062 in non-Aboriginals for a relative risk of 4.6 (95% CI = 2.7-7.7). For Manitoba only the relative risk was 5.8 (95% CI = 2.6-12.8). Using computerized administrative data from Manitoba the relative risk was 5.8 (95% CI = 1.3-25.8). CONCLUSION: There is an increased incidence of isolated TAPVD in Aboriginal peoples from Manitoba and Ontario. Further epidemiological investigation is necessary to determine the nature of this association.

Cohort Studies↗

PubMed2000

Do clinical databases render population-based cancer registers obsolete? The example of breast cancer in Denmark.

OBJECTIVE: Clinical databases have been invented to monitor treatment outcomes, therapies or diseases, often in great detail. The traditional population-based cancer registry has been invented to collect a minimum of information about all incident cancers. Do clinical databases render population-based cancer registers obsolete as sources of cancer cases for epidemiological study? METHODS: We compared the study base of first incident breast cancer cases in Denmark in 1978-1994 known from the national cancer register and from the national clinical database on breast cancer patients. The clinical database is used for monitoring protocoled treatment. RESULTS: Combining the two data sources we found 48,522 first primary breast cancers in Denmark 1978-1994. Of these, 37,640 were included in both data sources, 2151 were included only in the clinical database, and 8731 were included only in the cancer register. A major part of the difference between the two data sources was due to treatment-focused data collection in the clinical database, and a minor part due to differences in the registration of second primaries, date of diagnosis and invasiveness. CONCLUSIONS: Cancer incidence data are sensitive to registration procedures and definitions. Clinical cancer databases cannot generally replace the traditional cancer register as a reliable data source for incident cancer cases in a national population.

Adult↗

PubMed2004

Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.

OBJECTIVE: To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999. STUDY DESIGN: Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service. DATA COLLECTION: The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis. PRINCIPAL FINDINGS: Children classified as healthy (85.2 percent) had mean and median annual charges of dollar 485 and dollar 191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from dollar 2,303 to dollar 76,143 and from dollar 1,151 to dollar 19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges. CONCLUSIONS: Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.

Adolescent↗

PubMed1996

Mobile technology in rural hospitals: the case of the CT scanner.

OBJECTIVE: This study evaluates the relationship between hospital and regional characteristics and the prevalence of mobile computed tomography in rural hospitals. DATA SOURCES AND STUDY SETTING: Primary data were gathered from all rural hospitals in eight northwestern states (n = 471) in 1991. Secondary data sources include the AHA Annual Survey, the Area Resource File, and HCFA's PPS data sets for 1987-1990. STUDY DESIGN: Primary data are a single observation taken in the summer of 1991. Key hospital characteristics include patient volume, distance to the nearest referral center, distance to the nearest hospital, financial performance, and medical staff size. Key regional variables include beds per unit area, hospitals per unit area, and physician supply. DATA COLLECTION: A structured telephone interview was conducted with the hospital administrator at each hospital. For many hospitals, detailed information was gathered with additional calls to hospital personnel. PRINCIPAL FINDINGS: Where hospitals are closely spaced, mobile CT suppliers are more readily available, and hospitals are more likely to choose mobile CT than in areas where hospitals are farther apart. Hospitals may realize economies of scale and scope in their decisions about CT adoption. CONCLUSIONS: Transportation costs are an important determinant of hospital decisions about acquiring CT, but may be less important for higher-priced medical technologies. There is no support for the proposition that rural hospitals compete with referral centers for patients by purchasing technological equipment.

Catchment Area, Health↗

PubMed2000

Estimating the numbers of refugees in London.

BACKGROUND: Local populations of refugees and asylum seekers are growing in many urban areas in Western Europe and it is increasingly important to develop health and welfare services that are appropriate for these groups. However, in the United Kingdom there are no routine data sources at local level that give even the most basic information such as the numbers of refugees within a given area. METHODS: The total number of asylum seekers entering the United Kingdom was calculated using cumulative data on asylum seekers at national level. This population was then apportioned first to Greater London and then to the boroughs within London. The apportionment to London boroughs was based on analysis of four datasets. In the absence of any better evidence, an average of these four approaches was used to produce the final borough level estimates. RESULTS: The total numbers of refugees and asylum seekers in London who have entered the United Kingdom over the past 15 years was estimated to be between 240,000 and 280,000. At borough level the estimates of refugee populations ranged from under 1,000 to values up to 20,000. There were statistically significant associations between the four data sources when the proportions of the London total in each borough were compared. However, for some boroughs there could be large differences between estimates based on different data sources. CONCLUSION: The estimates provided give an indication of the size of the refugee population in London. None of the data sources used to apportion the London total were ideal and all were proxy values with their own strengths and weaknesses. This work points to the importance of developing information systems that in future will allow better estimates of the size of the refugee populations. This is particularly important in view of the UK national policy of dispersal proposed in the latest Immigration and Asylum Act.

Adult↗

PubMed2002

DataServer: an infrastructure to support evidence-based radiology.

Following a requirements analysis for development of an information infrastructure supporting evidence-based radiology, the objective of this study was the development of a data gateway to support flexible access to the totality of a patient's electronic medical records through a single, uniform representation, regardless of the underlying data sources (eg, hospital information systems [HIS], radiology information systems [RIS], picture archiving and communication systems [PACS]). XML-based (eXtensible Markup Language) technologies were employed to create an application framework permitting querying of different clinical databases. The contents of different data sources were represented by using XML. On the basis of these representations, users can specify queries. The system transforms the XML queries into a query format understood by the specific databases, processes the query, and transforms the results back into an XML format. XML results can then be transformed in accordance to different data-formatting standards. Access to several different data sources, including HIS, RIS, and PACS, has been accomplished with this framework. The extensible nature of the XML data gateway enables data sources to be readily added. The framework also provides a means by which data can be systematically de-identified to protect patient confidentiality, thus supporting research endeavors.

Evidence-Based Medicine↗

PubMed1984

A low-cost chromatograph data-collection system.

A data collection system has been constructed, based on the low-cost BBC microcomputer, which provides for the digitization and storage of the data from one or more g.l.c. or h.p.l.c. instruments, or from other data sources with similar data rates. The data can be observed during collection on the graphics screen, and are then stored on disk for subsequent processing. This processing is designed to be interactive, so that the operator can influence decisions about base-line drifts, peak separations, etc. when integrating the peaks, and can decide which peaks are to be stored in a time/intensity record, on the basis of a visual display of the trace. A low cost multi-channel precision ADC, using isolated voltage-to-frequency transducers sited at the sources of data, and multiple counters at the computer, may be used to measure several signals simultaneously even when they originate at some distance from the computer, and extra memory can also be added to the BBC microcomputer to allow temporary storage of data. The software is written in machine code (for the data collection) and BASIC (for the analysis routines) so that modifications to the latter routines can be made easily. The user interface is suitable for routine users who have no computing experience.

Chromatography↗

PubMed2005

Assessment of immunization registry databases as supplemental sources of data to improve ascertainment of vaccination coverage estimates in the national immunization survey.

OBJECTIVE: To evaluate the use of immunization registry data to supplement missing or incomplete vaccination data reported by immunization providers (referred to as "providers" hereafter) in the National Immunization Survey. DESIGN: Cross-sectional, random-digit-dialing, telephone survey to measure vaccination coverage among children aged 19 to 35 months in the United States. SETTING: Four sites with mature (with >67% of provider participation in the area) immunization registries. PARTICIPANTS: Of the 639 children with complete household interviews, interviewers had consent from the respondents for 569 (89.0%) children to contact their providers and for 556 (87.0%) children to contact both providers and registries. MAIN OUTCOME MEASURES: Percentages of children up-to-date for vaccines based on data from providers, registries, and both sources combined. RESULTS: According to provider-reported data, weighted estimates of coverage for the recommended childhood vaccine series 4:3:1:3 at the 4 sites were 65.6%, 78.8%, 81.6%, and 77.0%. According to registry data, these coverage rates were consistently lower: 31.7% (P<.05), 65.4%, 71.9%, and 61.8%, respectively. When all unique vaccine doses were combined from both sources, the pooled 4:3:1:3 coverage rates increased to 72.0%, 92.0%, 88.7%, and 80.2%, respectively. The quality and completeness of vaccination histories from the registries were inconsistent and varied by sites. CONCLUSIONS: Vaccination coverage estimates were the lowest when only registry-reported data were used and were the highest when provider- and registry-reported histories were combined. Although registries enrolled and matched more children, vaccination histories were missing, incomplete, and inconsistent. The quality and completeness of the registry data must be improved and must be comparable across all states before further consideration may be given to supplement or replace the provider-reported National Immunization Survey data.

Child, Preschool↗

PubMed1994

[Responsibilities and problems in national health reporting].

Complaints about the inadequate data situation in public health services are not new. However, during the course of the past few years there have been significant developments: the board of experts for concerted action in the public health services requested an improvement to the situation and the Federal Government promoted a preliminary study on the establishment of a national health reporting system (GBE) in Germany. Under the responsibility of the Federal Statistics Office, a national GBE is currently being established through further promotion by the Federal Ministry for Research and Technology (BMFT) and the Federal Health Ministry (BMG); the standard users of this system will be both the general public as well as the bodies responsible for health policy and scientific research. In the public health services there exist complete, but improveable data sources or incomplete sources requiring selection; also, new data sources must be won. In establishing the GBE, it is being assumed that public health services participants willing to cooperate already have at their disposal extensive data that does not need to be newly acquired, but does need improved mutual co-ordination. The GBE can be established on this. Further supplementary data acquisition is only being considered for a later stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗

PubMed2003

JXP4BIGI: a generalized, Java XML-based approach for biological information gathering and integration.

MOTIVATION: In the post-genomic era, biologists interested in systems biology often need to import data from public databases and construct their own system-specific or subject-oriented databases to support their complex analysis and knowledge discovery. To facilitate the analysis and data processing, customized and centralized databases are often created by extracting and integrating heterogeneous data retrieved from public databases. A generalized methodology for accessing, extracting, transforming and integrating the heterogeneous data is needed. RESULTS: This paper presents a new data integration approach named JXP4BIGI (Java XML Page for Biological Information Gathering and Integration). The approach provides a system-independent framework, which generalizes and streamlines the steps of accessing, extracting, transforming and integrating the data retrieved from heterogeneous data sources to build a customized data warehouse. It allows the data integrator of a biological database to define the desired bio-entities in XML templates (or Java XML pages), and use embedded extended SQL statements to extract structured, semi-structured and unstructured data from public databases. By running the templates in the JXP4BIGI framework and using a number of generalized wrappers, the required data from public databases can be efficiently extracted and integrated to construct the bio-entities in the XML format without having to hard-code the extraction logics for different data sources. The constructed XML bio-entities can then be imported into either a relational database system or a native XML database system to build a biological data warehouse. AVAILABILITY: JXP4BIGI has been integrated and tested in conjunction with the IKBAR system (http://www.ikbar.org/) in two integration efforts to collect and integrate data for about 200 human genes related to cell death from HUGO, Ensembl, and SWISS-PROT (Bairoch and Apweiler, 2000), and about 700 Drosophila genes from FlyBase (FlyBase Consortium, 2002). The integrated data has been used in comparative genomic analysis of x-ray induced cell death. Also, as explained later, JXP4BIGI is a middleware and framework to be integrated with biological database applications, and cannot run as a stand-alone software for end users. For demonstration purposes, a demonstration version is accessible at (http://www.ikbar.org/jxp4bigi/demo.html).

Database Management Systems↗

PubMed2006

Characteristics that predict locating and interviewing mothers identified by a state birth defects registry and vital records.

BACKGROUND: State vital records are often used to select population-based controls in record-linkage studies of birth defects. However, locating and contacting individuals based on these data sources to collect additional data can be a challenge. METHODS: A large case-control study of air quality and birth defects was conducted in 7 Texas counties in which cases were selected from the Texas Birth Defects Registry and controls from state vital records. In 2004, data from these sources were used to trace mothers of cases and controls who delivered babies in the year 2000 (n=2477) for participation in a computer-assisted telephone interview. A number of factors that predicted whether an individual would be located and interviewed were identified. RESULTS: Between March and August 2004, 38% of the mothers were located, and 38% of the located mothers were interviewed. Case mothers were more likely than control mothers to be located (44 vs. 30%) and, if located, to be interviewed (43 vs. 31%). We compared the characteristics of mothers who were not located (case n=760; control n=777), mothers who were located but not interviewed (case n=344; control n=236), and mothers who were interviewed (case n=256; control n=104). Among both cases and controls, older mothers (>or=30 years) were more likely than younger mothers to be located, and non-Hispanic black mothers were least likely to be located and interviewed. CONCLUSIONS: Despite the utility of vital records as a source of population-based controls in record-linkage analyses, the poor response rate discourages the use of these data sources to contact individuals for a follow-up study 4 years after delivery.

Case-Control Studies↗