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PubMedDate not supplied

Reanalysis of the Harvard Six Cities Study, part I: validation and replication.

Because the results of the Harvard Six Cities Study played a critical role in the establishment of the current U.S. ambient air quality objective for fine particles (PM(2.5)), the U.S. Environmental Protection Agency, industry, and nongovernmental organizations called for an independent reanalysis of this study to validate the original findings reported by Dockery and colleagues in the New England Journal of Medicine (vol. 329, pp. 1753-1759) in 1993. Validation of the original findings was accomplished by a detailed statistical audit and replication of original results. With the exception of occupational exposure to dust (14 discrepancies of 249 questionnaires located for evaluation) and fumes (15/249), date of death (2/250), and cause of death (2/250), the audit identified no discrepancies between the original questionnaires and death certificates in the audit sample and the analytic file used by the original investigators. The data quality audit identified a computer programming problem that had resulted in early censorship in 5 of the 6 cities, which resulted in the loss of approximately 1% of the reported person-years of follow-up; the reanalysis team updated the Six Cities cohort to include the missing person-years of observation, resulting in the addition of 928 person-years of observation and 14 deaths. The reanalysis team was able to reproduce virtually all of the original numerical results, including the 26% increase in all-cause mortality in the most polluted city (Stubenville, OH) as compared to the least polluted city (Portage, WI). The audit and validation of the Harvard Six Cities Study conducted by the reanalysis team generally confirmed the quality of the data and the numerical results reported by the original investigators. The discrepancies noted during the audit were not of epidemiologic importance, and did not substantively alter the original risk estimates associated with particulate air pollution, nor the main conclusions reached by the original investigators.

Air Pollutants↗

PubMed2001

Use of continuous water quality records for hydrograph separation and to assess short-term variability and extremes in acidity and dissolved carbon dioxide for the River Dee, Scotland.

A combination of continuous (15-min) pH, conductivity and temperature measurements and fortnightly spot-sampled water quality data were used to examine temporal variability and extremes in river water quality in an upland Scottish river: the River Dee at Mar Lodge. An empirical relationship was established for Gran-alkalinity by multiple regression against flow and conductivity for the fortnightly data. Applying this relationship to the continuous data, an estimate of continuous Gran-alkalinity was calculated. The continuous Gran-alkalinity record was used as (1) a conservative tracer in a simple two-component mixing model to determine the relative proportions of near-surface runoff and deeper groundwater contributing to stream flow; (2) to deconvolute the contribution of weathering and sea-salt contributions to stream conductivity; and (3) to calculate the excess partial pressure of carbon dioxide in stream water. The episodic variations in pH, weathering and sea-salt conductivity and excess partial pressures of carbon dioxide (EpCO2) associated with high flow events in the River Dee suggest that hydrological pathways play an important role in determining stream chemistry. The results of the hydrograph separation indicate that groundwater provides an important contribution to stream flow, and that there are large and hydrologically active stores of groundwater within the upper River Dee catchment. Sea-salts have an important influence on stream conductivity, particularly with the onset of storm runoff following summer drought periods. This suggests that sea-salts are concentrated in the upper soil horizons by dry deposition and/or evapotranspiration. EpCO2 behaves non-conservatively and shows marked diurnal variability under low-flow conditions during summer, inducing diurnal pH variations, and indicating the importance of within-river biological processes. This study emphasises the very intermittent nature of water quality extremes with stream spates and the diurnal nature of biologically-induced responses. Fortnightly sampling programmes do not capture the range of high flow extremes, and with sampling undertaken during the working day, biological extremes occurring at night are also missed, introducing bias. This study shows the value of continuous measurements for infilling aspects of these intermittent extremes. However, it is also noted that the relatively simple patterns of response observed from the continuous measurements may well belie a much more varied response at the sub-catchment and hillslope scales, as local chemical and hydrological heterogeneities do occur. Thus, the two-component mixing model used is, in practice, based on catchment integrated values for a range of soil water and groundwater endmembers.

Carbon Dioxide↗

PubMedDate not supplied

What clinicians should know about the QT interval.

CONTEXT: Of the several factors implicated in causing QT interval prolongation and torsades de pointes, errors in the use of medications that may prolong this interval deserve special attention. OBJECTIVE: To systematically summarize the available clinical data on the QT interval and to offer improved recommendations for the use of QT-prolonging medications. DATA SOURCES: We searched MEDLINE from 1966 through 2002 for all English-language articles related to the QT interval. Additional data sources included bibliographies of articles identified on MEDLINE, a survey of experts, and data presented at a meeting of experts on long QT syndrome. STUDY SELECTION: We selected for review registries and case series examining clinical outcomes of patients with prolonged QT interval and the effect of different methods of measurement of the QT interval on patient outcomes. Ten studies were identified, of which 6 were included in the analysis. DATA EXTRACTION: Data quality was determined by publication in the peer-reviewed literature. DATA SYNTHESIS: Optimal measurement of the QT interval is problematic because of lack of standardization and lack of data regarding the best way to adjust for heart rate. Reliable information on the proper use of QT-prolonging medications is scarce. Although a QT interval of at least 500 milliseconds generally has been shown to correlate with a higher risk of torsades de pointes, there is no established threshold below which prolongation of the QT interval is considered free of proarrhythmic risk. The risk of torsades de pointes should be assessed in patients who are about to begin taking a QT-prolonging medication. Although inadequate clinical studies preclude prediction of absolute risk for individual patients, particularly high-risk situations can be defined based on clinical variables. We propose recommendations on proper monitoring of the QT interval in patients receiving QT-prolonging medications. CONCLUSION: Although the use of QT-prolonging medications can predispose to torsades de pointes, there is a relative paucity of information that can help clinicians and patients make optimal informed decisions about how best to minimize the risk of this serious complication.

Drug Interactions↗

PubMed1996

Microsurgery in a rat lung transplant model: analysis of benefit.

With the use of microsurgery, we have developed a method of measuring hemodynamic parameters in a rat not possible with previous technology. Three groups of rats were studied: a chemically induced pulmonary hypertensive group (PH); a chemically induced pulmonary hypertensive group treated with single lung transplantation (LT); and an untreated, control group (C). Cardiac output, heart rate, and pulmonary vascular resistance were then calculated in each group from data obtained by 1 mm high fidelity micromanometers and an ultrasonic flow probe. The results show that the data collected from the rodent model are reproducible within each group, and data quality is comparable to large animal models. With this new method, data can be collected in a small animal model at a fraction of the time and cost of large animal studies. Additionally, the complications of graft rejection in large animal studies are eliminated in an isogenic rodent model.

Animals↗

PubMed2005

[Method and design of the Telephone Health Survey 2003].

Telephone surveys are increasingly being used in public health research, also in Germany. In 2003 the Robert Koch Institute completed the first nationwide telephone survey predominantly on conditions and prevalence of selected chronic diseases (GSTel03). Its findings are presented in this publication. The tasks of planning, implementation and realization of procedures used in telephone surveys differ in many aspects from other modes of data collection. This article deals with the most important methodological aspects that were implemented and used in the course of the GSTel03 to ensure a high level of data quality. These include sample design, questionnaire development and the process of data collection (including the recruitment and training of the staff). Finally steps of data preparation for analysis including weighting procedures are described and calculation of contact and cooperation rates are reported.

Data Interpretation, Statistical↗

PubMed2006

Properties of a federated epidemiology query system.

PURPOSE: The purpose of the study was to establish knowledge about how online access to epidemiological data from general practitioners (GPs) electronic health record (EHR) system should be provided. Before such systems are developed and deployed a decision about the appropriate system architecture must be made. Such a decision should ideally be based on knowledge about the properties of different system architectures. This choice is important because the system architecture may affect the willingness of GPs to participate in providing epidemiological data from their EHR system. METHOD: Verifying the performance and properties of an architectural approach by implementing and deploying a system on a trans-institutional level and performing evaluations studies is a very resource demanding method to establish a foundation for the decision of appropriate system architecture. Instead, we have tried to create this foundation by constructing a prototype system, establish knowledge about the properties of the system using experiments, and finally compare the properties of the federated approach to the properties of the centralised approach. By using this methodological approach we provide the best available knowledge, on this stage, for the appropriate system architecture to use for providing access to epidemiological data from the local population. RESULTS: Our experimental results show that it is possible to improve the timeliness and the temporal and spatial resolution of epidemiological data, compared to traditional centralised disease surveillance systems. Up-to-date epidemiological data from the local population may be provided directly from the source EHR system within 4s. The responsiveness of the system is minimally affected (0.1s) as the number of participating data providers grows from 1 to 49 data providers. The comparison of the federated approach to the centralised approach indicates that federated approaches avoid the privacy issues involved, as intended; it offers better scalability when computing speed is compared, and it provides better specificity because more data about the patient may be used. CONCLUSION: The conclusion from our study is that the federated approach to providing epidemiological data about the local population has many benefits over the traditional centralised approach. A federated approach to an epidemiology system may raise the GPs awareness of local disease outbreak because it is possible to share information about incidence rates of communicable diseases and use of laboratory requests in a geographical area that predates laboratory-based disease surveillance. The effects of the federated approach could be improved data quality in the EHR systems and improved representativeness of the epidemiological data for the areas covered by such systems.

Database Management Systems↗

PubMed2002

Virtues of a worldwide congenital heart surgery database.

The rationale for a congenital heart surgery database lies in the organized manner in which information can be compiled to accomplish programmatic evaluation, monitor clinical outcomes, comply with governmental requirements, perform retrospective and prospective clinical studies, and participate in local, national, and global improvement strategies. The task of inaugurating an effective congenital heart surgery database has taken many years and involved concurrent development efforts at multiple sites. Two such efforts took place in North America with the Society of Thoracic Surgeons Congenital Heart Surgery Database, and in Europe with the European Congenital Heart Defects Database. These initial efforts provided the impetus for development of an international congenital heart surgery database that would allow scientific exchanges on an international scale and promote multi-institutional evaluation of congenital heart surgery. Sample outcome templates from the Society of Thoracic Surgeons and the European Association for Cardio-thoracic Surgery's accepted minimum database data set are reviewed for the specific diagnostic entry ventricular septal defect, to familiarize the reader with potential available data summaries and outcome analyses, including risk stratification, when data harvest is performed. In Europe, the agreed upon minimum data set are now collected as part of the Pediatric European Cardiac Surgical Registry, while in North America users of the CardioAccess database and users of the minimum data set downloaded from the Society of Thoracic Surgeons web site are being notified of plans for a 2002 data harvest incorporating the minimum database data set. It is likely that the extant voluntary, minimal data set congenital heart surgery database will be replaced by a mandated system required by states, provinces, and countries. Data collection schemes and data validation programs will become standardized, which will result in improved data quality and uniform congenital heart center participation. As participation with valid data approaches 100% of congenital heart centers, the power and importance of the database increases exponentially. Reliable information can be used to assess residency/fellowship programs, resource allocation, major therapeutic trends, manpower issues, and in the end, all initiatives that will require accurate information.

Databases, Factual↗

PubMed2001

Smoke impacts from agricultural burning in a rural Brazilian town.

Agricultural and silvicultural biomass burning is practiced in many undeveloped portions of the Amazon basin. In Rond nia, Brazil, such burning is restricted to a brief period in the dry season of August and September to minimize the duration of air quality impacts and to attempt to control escaped fires. During this period, much of the region and the communities within it experience significant exposure to smoke from agricultural and forest fires. In cooperation with Brazilian scientists of the University of Brasilia, the Brazilian Organization for Agricultural Research (EMBRAPA), and the Alternative to Slash and Burn Program coordinated by the International Center for Research in Agroforestry (ICRAF), ambient air quality was measured in Theobroma, a small town in Rond nia, during one week of the open burning period of 1995 to supplement available air quality data and to foster public awareness of the impacts of widespread fires. Personal sampling equipment was used to measure ambient levels of formaldehyde (HCHO), acrolein, CO, benzene, and respirable PM in outdoor air. The data obtained were compared with established Brazilian and U.S. ambient air quality guidelines. Ambient levels of respirable PM averaged 191 microg/m3, HCHO averaged 12.8 ppb, CO averaged 4.2 ppm, and benzene averaged 3.2 ppb. Almost all acrolein samples were less than the detection limit of 1 ppb. The results showed that the public can be exposed to relatively high levels of pollutants under the prescribed burning smoke management strategy of a two- to three-week prescription burning period, although this is an improvement over past years when burning was unregulated and continued through most of the dry season. The results also demonstrate the feasibility of using personal exposure monitoring equipment for low-cost surveys of ambient air quality in polluted regions.

Agriculture↗

PubMed2003

Bayes estimation of species divergence times and ancestral population sizes using DNA sequences from multiple loci.

The effective population sizes of ancestral as well as modern species are important parameters in models of population genetics and human evolution. The commonly used method for estimating ancestral population sizes, based on counting mismatches between the species tree and the inferred gene trees, is highly biased as it ignores uncertainties in gene tree reconstruction. In this article, we develop a Bayes method for simultaneous estimation of the species divergence times and current and ancestral population sizes. The method uses DNA sequence data from multiple loci and extracts information about conflicts among gene tree topologies and coalescent times to estimate ancestral population sizes. The topology of the species tree is assumed known. A Markov chain Monte Carlo algorithm is implemented to integrate over uncertain gene trees and branch lengths (or coalescence times) at each locus as well as species divergence times. The method can handle any species tree and allows different numbers of sequences at different loci. We apply the method to published noncoding DNA sequences from the human and the great apes. There are strong correlations between posterior estimates of speciation times and ancestral population sizes. With the use of an informative prior for the human-chimpanzee divergence date, the population size of the common ancestor of the two species is estimated to be approximately 20,000, with a 95% credibility interval (8000, 40,000). Our estimates, however, are affected by model assumptions as well as data quality. We suggest that reliable estimates have yet to await more data and more realistic models.

Algorithms↗

PubMed1994

Cryo automated electron tomography: towards high-resolution reconstructions of plastic-embedded structures.

The use of fully automated data collection methods for electron tomography allows a substantial reduction in beam dose. The goal has been to develop new protocols for data collection defining optimal approaches for maintaining data self-consistency and maximizing the useful resolution of the reconstruction. The effects of irradiation and post-cure microwaving were examined for a variety of embedding media (Epon, Epox, Lowicryl) in order to quantify beam damage with the goal of identifying the most beam stable embedding medium. Surprisingly, the substantial dose reduction made possible by automated data collection did not result in a significant decrease in specimen shrinkage even for samples stabilized by pre-irradiation. We believe that the accelerated shrinkage is a direct consequence of the stroboscopic illumination patterns inherent to automated data collection. Furthermore neither the choice of embedding resin nor microwave post-curing greatly affected shrinkage. Finally, cryogenic data collection was investigated as a means to minimize the effects of secondary radiation damage. Minimal pre-irradiation coupled with low-temperature automated data collection greatly reduces shrinkage and should result in high-quality data for three-dimensional reconstructions.

Cryopreservation↗

PubMed2002

Analysis of environmental and biologic methyl parathion data to improve future data collection.

The Agency for Toxic Substances and Disease Registry analyzed concurrently collected data on environmental methyl parathion (MP) and urinary p-nitrophenol (PNP) at the request of the U.S. Environmental Protection Agency (U.S. EPA). The purpose of the analysis was to assess whether individuals' age or level of residential MP contamination might predict their urinary PNP level. Unlicensed pesticide applicators had sprayed residences in Mississippi with MP, which is approved as a pesticide only for outdoor agricultural use. Data were received from Mississippi for MP wipe sample levels for 409 homes and urinary PNP levels for 929 residents of the residences sampled. In addition to descriptive and bivariate analyses, ordinal logistic regression was performed after categorizing the data. Interpretation of results was limited by several identified data gaps and pre-existing data-quality issues. On the basis of the lessons learned from identified data gaps, specific recommendations were made to the U.S. EPA for improving future data collection methods for more meaningful exposure assessment in similar environmental contaminations. The recommended changes were successfully incorporated in subsequent data collected by other states that had experienced similar residential MP spraying.

Agriculture↗

PubMedDate not supplied

Water quality impacts of converting to a poultry litter fertilization strategy.

When improperly managed, land application of animal manures can harm the environment; however, limited watershed-scale runoff water quality data are available to research and address this issue. The water quality impacts of conversion to poultry litter fertilization on cultivated and pasture watersheds in the Texas Blackland Prairie were evaluated in this three-year study. Edge-of-field N and P concentrations and loads in surface runoff from new litter application sites were compared with losses under inorganic fertilization. The impact on downstream nutrient loss was also examined. In the fallow year with no fertilizer application, nutrient losses averaged 3 kg N ha(-1) and 0.9 kg P ha(-1) for the cultivated watersheds and were below 0.1 kg ha(-1) for the pasture watersheds. Following litter application, PO(4)-P concentrations in runoff were positively correlated to litter application rate and Mehlich-3 soil P levels. Following litter application, NO(3)-N and NH(4)-N concentrations in runoff were typically greater from cultivated watersheds, but PO(4)-P concentrations were greater for the pasture watersheds. Total N and P loads from the pasture watersheds (0.2 kg N ha(-1) and 0.7 kg P ha(-1)) were significantly lower than from the cultivated watersheds (32 kg N ha(-1) and 5 kg P ha(-1)) partly due to lower runoff volumes from the pasture watersheds. Downstream N and P concentrations and per-area loads were much lower than from edge-of-field watersheds. Results demonstrate that a properly managed annual litter application (4.5 Mg ha(-1) or less depending on litter N and P content) with supplemental N should supply necessary nutrients without detrimental water quality impacts.

Animals↗

PubMedDate not supplied

Longevity of acid discharges from underground mines located above the regional water table.

The duration of acid mine drainage flowing out of underground mines is important in the design of watershed restoration and abandoned mine land reclamation projects. Past studies have reported that acid water flows from underground mines for hundreds of years with little change, while others state that poor drainage quality may last only 20 to 40 years. More than 150 above-drainage (those not flooded after abandonment) underground mine discharges from Pittsburgh and Upper Freeport coal seams were located and sampled during 1968 in northern West Virginia, and we revisited 44 of those sites in 1999-2000 and measured water flow, pH, acidity, Fe, sulfate, and conductivity. We found no significant difference in flows between 1968 and 1999-2000. Therefore, we felt the water quality data could be compared and the data represented real changes in pollutant concentrations. There were significant water quality differences between year and coal seam, but no effect of disturbance. While pH was not significantly improved, average total acidity declined 79% between 1968 and 1999-2000 in Pittsburgh mines (from 66.8 to 14 mmol H+ L(-1)) and 56% in Upper Freeport mines (from 23.8 to 10.4 mmol H+ L(-1)). Iron decreased an average of about 80% across all sites (from an average of 400 to 72 mg L(-1)), while sulfate decreased between 50 and 75%. Pittsburgh seam discharge water was much worse in 1968 than Upper Freeport seam water. Twenty of our 44 sites had water quality information in 1980, which served as a midpoint to assess the slope of the decline in acidity and metal concentrations. Five of 20 sites (25%) showed an apparent exponential rate of decline in acidity and iron, while 10 of 20 sites (50%) showed a more linear decline. Drainage from five Upper Freeport sites increased in acidity and iron. While it is clear that surface mines and below-drainage underground mines improve in discharge quality relatively rapidly (20-40 years), above-drainage underground mines are not as easily predicted. In total, the drainage from 34 out of 44 (77%) above-drainage underground mines showed significant improvement in acidity over time, some exponentially and some linearly. Ten discharges showed no improvement and three of these got much worse.

Coal↗

PubMed1976

Proficiency testing for blood-gas quality control.

We have conducted a voluntary, community blood-gas proficiency testing program, with use of tonometered human blood, for 32 analyzers located in 16 laboratories. Instruments initially showed inaccuracies as large as -30.8 to +17.3% for po(2), and -14.0 to +42.9% for pco(2), but inaccuracy and imprecision decreased in most laboratories during the program. For a typical 15-week period, mean group precision (CV) was 4.3 To 5.1% for po(2) from 6.92 to 33.3 Pa (52 to 250 mmHg), and 4.0 to 6.9% for pco(2) from 2.0 to 6.8 Pa (15 to 51 mmHg). This program can detect increasing imprecision or inaccuracy caused by analyzer deterioration, and can identify interlaboratory or interinstrument bias and problems not detected by participant quality-control programs. Participants have used the proficiency information in discussing data quality with clinicians, promoting internal control and maintenance programs, and justifying instrument purchases. We believe that proficiency-testing documentation of variability in blood-gas analysis may help to establish realistic patient-care protocols.

Analysis of Variance↗

PubMed2001

Sensitivity analysis of longitudinal binary quality of life data with drop-out: an example using the EORTC QLQ-C30.

Analysing quality of life data (QOL) may be complicated for several reasons. Quality of life data not only involves repeated measures but is also usually collected on ordered categorical responses. In addition, it is evident that not all patients provide the same number of assessments, due to attrition caused by death or other medical reasons. In the recent statistical literature, increasing attention is given to methods which can handle non-continuous outcomes in the presence of missing data. The aim of this paper is to investigate the effect on statistical conclusions of applying different modelling techniques to QOL data generated from an EORTC phase III trial. Treatment effects and treatment differences are of major concern. First, a random-effects model is fitted, relating a binary longitudinal response (derived from the physical functioning scale of the QLQ-C30) to several covariates. In a second approach, marginal models are fitted, retaining the response variable and the mean structure used before. The fitted marginal models only differ with respect to the considered estimation procedure: generalized estimating equations (GEE); weighted generalized estimating equations (WGEE), and maximum likelihood (ML).

Antibiotics, Antineoplastic↗

PubMed2005

[Information system in primary health care].

The Croatian Ministry of Health started a health care system computerization project aimed at strengthening the collaboration among health care institutions, expert groups and individual health care providers. A tender for informatic system for Primary Health Care (PHC) general practice, pediatrics and gynecology, a vital prerequisite for project realization, has now been closed. Some important reasons for undertaking the project include rationalization of drug utilization, savings through a reduced use of specialists, consultants and hospitalization, then achievement of better cooperation, work distribution, result linking, data quality improvement (by standardization), and ensuring proper information-based decision making. Keeping non-standardized and thus difficult to process data takes too much time of the PHC team time. Since, however, a vast amount of data are collected on only a few indicators, some important information may remain uncovered. Although decisions made by health authorities should rely on evidence and processed information, the authorities spend most of the time working with raw data from which their decisions ultimately derive. The Informatic Technology (IT) in PHC is expected to enable a different approach. PHC teams should be relieved from the tedious task of data gathering and the authorities enabled to work with the information rather than data. The Informatics Communication Technology (ICT) system consists of three parts: hardware (5000 personal computers for work over the Internet), operative system with basic software (editor, etc.), and PHC software for PHC teams. At the national level (National Public Health Informatics System), a software platform will be built for data collection, analysis and distribution. This data collection will be based on the International Classification of Primary Care (ICPC-2) standard to ensure the utilization of medical records and quality assessment. The system permits bi-directional data exchange between a central database and sources at different levels, across the spectrum from basic PHC teams to local authorities. This will enable data collection control, comparisons with national averages and prompt distribution of information over the Internet. The investment into IT is a strategic imperative having no alternative. A cost/benefit analysis has shown its operation in the PHC system to return the investment in two years. As defined according to the Project priorities (with measurable objectives), the use of new technologies will be introduced by stages.

Croatia↗

PubMed2004

Australian and New Zealand birth cohort studies: breadth, quality and contributions.

OBJECTIVE: To understand factors associated with successfully conducting longitudinal studies across early childhood by (i) describing the designs of Australian and New Zealand birth cohort studies; (ii) describing the breadth of variables studied; and (iii) identifying factors influencing study quality, productivity and contributions. METHODS: A systematic review was undertaken of 13 birth cohort studies. Data were collected from published papers and questionnaires administered to study investigators. RESULTS: These single cohort studies recruited children prior to their first birthday. Using an ecological model as an organizing framework, the studies were found to have contributed to knowledge about health and development in multiple domains and well beyond early childhood. Areas for increased focus included policy-relevant environmental factors such as child-care and rural/urban differences, and the influence of fathers, family factors, peers, social competence, and genetic factors. Investigators' responses indicated desires for an increased depth of data collection and stronger sampling designs. Data quality was enhanced by maintaining skilled staff and reduced by inadequate data for tracking study participants. Productivity ranged from 1 to 760 publications per study (median = 14.0). The most productive studies were those that had started before 1990, had representative samples, ongoing funding, and larger research teams. Policy impacts have included changed infant sleeping practices, reduced environmental lead emissions and regulated swimming pool safety standards. CONCLUSIONS: A suite of coordinated and nested studies could meet sampling needs and facilitate depth of inquiry. Stable, long-term funding is required to staff and maintain well-designed longitudinal studies that can address priority research areas and contribute to the development of health and social policy.

Australia↗

PubMedDate not supplied

Intranet-based multi-purpose medical records in orthopaedics.

Quality assurance in orthopaedics--as in any medical speciality--relies on precise medical records. Data quality is crucial for statistical evaluation; missing values cannot be avoided but must be minimized. The quality assurance system must be accessible from many locations within the clinic; given the complex and heterogeneous computing infrastructure this is a technological challenge. Intranet technology--the application of internet-tools in local networks--can help to solve the technical problems. A generic Intranet-based quality assurance system in orthopaedics was designed, implemented and evaluated. The basic concept is an intranet data entry form which is generated semi-automatically from the data definition. This form is adapted according to the individual needs of the doctors (intelligent data entry). By flexible data transformation the same data set is used for clinical reports as well as scientific evaluations. The first use was for ultrasound examinations of neonatal hips. A report form consisting of 56 items was designed. Within the first 9-month period 1303 cases have been documented.

Attitude of Health Personnel↗