Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Data Sources”

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

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

At least 1,189 records · Page 66Linked to original sources
PubMed1993

Fetal vibroacoustic stimulation.

OBJECTIVE: To review the literature on fetal vibroacoustic stimulation as a method of changing the fetal sleep state during nonstress testing. DATA SOURCES: The MEDLINE data base and reference lists were used to select articles pertaining to human and animal fetal vibroacoustic stimulation. METHODS OF STUDY SELECTION: We reviewed the English-language literature with respect to sound intensity, stimulus duration, and repetition rate as possible means of altering fetal sleep-wake cycles. DATA EXTRACTION AND SYNTHESIS: Several criteria have been used to measure fetal response: gestational age, fetal heart rate, fetal movements, fetal breathing movements, fetal habituation, and fetal behavioral states. The use of vibroacoustic stimulation for antepartum and intrapartum fetal assessment and safety issues are also reviewed. CONCLUSION: Although further research is needed, the ability of vibroacoustic stimulation to elicit FHR accelerations has been established, thus decreasing the false-positive rate associated with nonreactive nonstress testing.

Acoustic Stimulation↗
PubMed1995

The role of cladribine in the treatment of lymphoid malignancies.

PURPOSE/OBJECTIVES: To review clinical applications and nursing care activities for patients receiving cladribine, a synthetic antineoplastic agent used to treat lymphoid malignancies. DATA SOURCES: Clinical trial data, published articles, reports from oncology nurses, and personal observations. DATA SYNTHESIS: Cladribine has shown response rates of nearly 90% in patients with hairy cell leukemia after a single, seven-day continuous infusion. Toxicities generally are mild, predictable, and rapidly reversible after therapy is discontinued. CONCLUSIONS: Currently, cladribine primarily is used in hairy cell leukemia therapy. Clinical trials of cladribine in treating other hematologic malignancies, primarily chronic lymphocytic leukemia and non-Hodgkin's lymphoma, have demonstrated encouraging results. IMPLICATIONS FOR NURSING PRACTICE: Nursing care for patients who receive cladribine involves management of side effects, which commonly include myelosuppression and fever, and monitoring of hemoglobin, platelet levels, and body temperature. Fever develops in most patients receiving cladribine but is usually transient and easily treated with acetaminophen. Infection as a cause of fever must be ruled out, especially in patients with neutropenia.

Antineoplastic Agents↗
PubMed1996

Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems.

OBJECTIVE: This study calculated the risk of nursing home admission for clients receiving home- and community-based (HCB) care in a capitated long-term care system. DATA SOURCES: Program administrative data for non-institutionalized elderly and physically disabled (EPD) clients who had an HCB long-term care placement in the Arizona Long-Term Care System (ALTCS) during the period from January 1989 through December 1991. STUDY DESIGN: The program experience of clients who were initially placed in HCB care (N = 2,923) was tracked from the date on which they entered the program until the end of December 1992. DATA EXTRACTION METHODS: Program administrative data were used to create spans of program experience for each client. Cox proportional hazards regression models were then used to assess the individual factors associated with the risk of nursing home entry during the study period. PRINCIPAL FINDINGS: The greatest risk of nursing home entry was observed for those who were older or white, and for those clients with Alzheimer's disease. Little significant effect was observed for support system variables. CONCLUSIONS: Study results suggest that efforts to prevent nursing home entry may be most productive if they focus on the point at which clients are first assessed for placement into the ALTCS program. Once in HCB care, subsequent risk of nursing home placement may be more related to the client's health and frailty than to support system factors.

Activities of Daily Living↗
PubMed1996

Strontium-89 for treatment of painful bone metastasis from prostate cancer.

PURPOSE/OBJECTIVE: To review the current use of strontium-89 (89Sr) to treat pain related to bony metastasis secondary to prostate cancer. DATA SOURCES: Published articles. DATA SYNTHESIS: Prostate cancer is the most commonly diagnosed cancer in the United States. The disease's most common site of metastasis is the bones. Bone metastasis leads to unrelenting pain. If healthcare providers are able to manage a patient's pain successfully, the patient's quality of life improves. CONCLUSION: When conventional therapies fail, 89Sr can be used as an alternative or an adjunct to pain management of bony metastasis in prostate cancer. IMPLICATIONS FOR NURSING PRACTICE: Nursing intervention primarily involves assessing pain, monitoring analgesics until 89Sr can begin to take effect, educating patients on using other medications with 89Sr, and assessing fatigue resulting from 89Sr-induced myelosuppression. As pain decreases, nurses also should monitor patients' activity levels, since they are at risk for pathologic fractures.

Bone Neoplasms↗
PubMedDate not supplied

Relieving nausea and vomiting in patients with cancer: a treatment algorithm.

PURPOSE/OBJECTIVES: To describe a treatment algorithm for the choice of antiemetic therapy for the patient receiving chemotherapy. DATA SOURCES: Published literature, data collected on an inpatient oncology unit. DATA SYNTHESIS: Because little information is available to systematically guide clinicians in choosing the best antiemetic for an individual patient who is receiving a particular chemotherapy protocol, a treatment algorithm was developed. The four main variables include emetogenicity of the protocol, patient's age, previous adverse reaction to antiemetics, and failure of previous antiemetics. Other factors to consider include alcohol use, anticipatory nausea, patient health status, nausea history not related to chemotherapy, and type and availability of IV access. CONCLUSION: The use of this algorithm resulted in appropriate choice of antiemetics and improved patient outcomes associated with reduced incidence of nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: Nurses can have a significant impact on a patient's experience with chemotherapy treatment by improving symptom management of nausea and vomiting.

Adult↗
PubMed1996

[Prevalence and incidence. These (almost) unknowns].

OBJECTIVES: The purpose of the study is to point out some aspects of the most used terms in epidemiology, that is, erroneously, considered a simple and easy subject, but is often incorrectly applied, even in scientific studies. Sometimes the difficulties encountered in the application of epidemiology are underestimated; before the beginning of every scientific study the authors must be perfectly aware of the differences existing between different terms, even if very small. This for the optimal design of the study, and in order to gather as many data as possible and to draw correct conclusions for the readers and for other investigators. DATA SOURCES: The author reviewed indexed journals of Anesthesia of the last ten years looking for studies where epidemiological terms have been used, in order to better evaluate how frequently they occurred and if in the proper way. CONCLUSIONS: Sometime in the scientific literature these concepts are wrongly used, and this can be a source of incorrect data for both the reader and other investigators. Properly applied epidemiological concepts enhance the validity of the reported data and constitute a solid base of the paper itself.

Anesthesia↗
PubMed1997

Comparison of responses to SF-36 Health Survey questions with one-week and four-week recall periods.

OBJECTIVE: To compare the measurement properties of acute (one-week recall) and standard (four-week recall) versions of SF-36 Health Survey (SF-36) scale scores. DATA SOURCES: SF-36 data collected from 142 participants (60% female, average age 39) in a clinical trial of an asthma medication: 74 patients randomized to the acute form and 68 to the standard. DATA COLLECTION: The SF-36 was self-administered at the time of a clinic visit (before clinical examination) to synchronize with clinical measures of disease severity at three different time points during the clinical trial: -2 weeks (two weeks before randomization to treatment), baseline (week 0 or randomization), and +4 weeks (four weeks after baseline). PRINCIPAL FINDINGS: The acute form yielded high-quality data; scales conformed to the assumptions of the summated ratings method used to score the standard SF-36; and scales had good distributional properties, were reliable, and had a factor content similar to the standard. The data indicated that while the acute form was more sensitive than the standard to change in health status associated with changes in acute symptoms, acute scale scores may not be comparable to national norms based on the standard, particularly for those scales that assess frequency of health events during a specified time period. CONCLUSIONS: Results support the use of the acute form in its intended applications; however, further research is required to document the generalizability of greater sensitivity of the acute form to recent changes in health and to explore whether norms based on the standard can be used to interpret the acute scale scores.

Adolescent↗
PubMed1997

Nonpharmacologic management of chemotherapy-induced nausea and vomiting.

PURPOSE/OBJECTIVES: To review the nonpharmacologic interventions indicated to prevent or control chemotherapy-induced nausea and vomiting. DATA SOURCES: Journal articles. DATA SYNTHESIS: Despite improvements in antiemetic drug therapy, as many as 60% of patients with cancer who are treated with antineoplastic agents experience nausea and vomiting. Anticipatory nausea and vomiting are thought to be caused by the behavioral process of classical conditioning. Most nonpharmacologic interventions that are used to prevent or control nausea and vomiting in patients with cancer are classified as behavioral interventions. Behavioral interventions involve the acquisition of adaptive behavioral skills to interrupt the conditioning cycle. CONCLUSIONS: Nonpharmacologic interventions appear to be effective in reducing anticipatory and post-treatment nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: These behavioral interventions can be effective in reducing anticipatory and post-treatment nausea and vomiting. Oncology nurses must learn these nonpharmacologic techniques and teach their patients to use them in combination with their prescribed antiemetic therapy.

Acupressure↗
PubMed1997

Are spiral ganglion cell numbers important for speech perception with a cochlear implant?

OBJECTIVE: Studies of factors affecting the survival of ganglion cells in adults with profound hearing loss and speech perception in cochlear implant users are reviewed in order to assess the hypothesis that ganglion cell numbers have a strong influence on the level of speech perception achieved by adult implant users. DATA SOURCES: All histopathologic data have been published as tables or figures in refereed papers. Speech perception data were collected from published papers and directly from clinics and from Cochlear Corporation's database. STUDY SELECTION: Histopathologic studies with reasonably large groups of patients were selected. The speech perception data were from the largest study available. DATA EXTRACTION: All data used have been published in refereed journals of high repute. No other assessment of quality or validity was available to the author. DATA SYNTHESIS: Trends in the speech perception data were compared qualitatively and quantitatively with trends in the histopathologic ganglion cell data. CONCLUSIONS: The analysis found no strong evidence that spiral ganglion cell numbers have a strong influence on the level of speech perception achieved with a cochlear implant. A possible explanation for this surprising result may be that the minimum number of cells required for good speech perception is quite low, and the majority of implant users exceed this minimum requirement.

Adolescent↗
PubMed1997

The determinants of dumping: a national study of economically motivated transfers involving mental health care.

OBJECTIVE: To examine the prevalence and determinants of economically motivated transfers (aka "dumping") from hospitals treating mental illness. DATA SOURCES: A composite data set constructed from three national random-sampled surveys conducted in 1988 and 1989: (1) of hospitals providing mental health care, (2) of community mental health centers, and (3) of psychiatrists. STUDY DESIGN: The study uses reports from administrators of community mental health centers (CMHCs) to assess the extent of patient dumping by hospitals. To assess the determinants of dumping, reported perceptions of dumping are regressed on variables describing the catchment area in terms of the proportion of for-profit hospitals, intensity of competition among hospitals, extent of utilization review, and capacity of the local treatment system, as well as competition among community mental health centers. To assess if dumping is motivated by factors distinct from those affecting other aspects of access, comparable regressions are estimated with ease of hospital admission as the dependent variables. PRINCIPAL FINDINGS: Economically motivated transfers of psychiatric patients were widespread in 1988: according to the reports of CMHC administrators, 64.7 percent of all hospitals providing inpatient mental health care engaged in transfers of this sort. The extent of dumping was higher in catchment areas with more competition among hospitals, more proprietary hospitals, and less inpatient capacity in the public sector. Dumping appeared to be more sensitive to capacity in the public sector but less sensitive to involvement by for-profit hospitals than were other measures of access to care. CONCLUSIONS: Economically motivated transfers of patients with mental illness were widespread in 1988 and likely have increased since that time, affecting the viability of the community mental health care system.

Adolescent↗
PubMed1998

Factors associated with women's adherence to mammography screening guidelines.

OBJECTIVE: To examine individual and environmental factors associated with adherence to mammography screening guidelines. DATA SOURCES: A unique data set that combines a national probability sample (1992 National Health Interview Survey); a national probability sample of mammography facility characteristics (1992 National Survey of Mammography Facilities); county-level data on 1990 HMO market share; and county-level data on the supply of primary care providers (1991 Area Resource File). STUDY DESIGN: The design was cross-sectional. DATA EXTRACTION/ANALYSIS: Data sets were linked to create an individual-level sample of women ages 50-74 (weighted n = 2,026). We used multipart, sequential logistic regression models to examine the predictors of having ever had mammography, having had recent mammography, and adherence to guidelines. We categorized women as adherent if they reported a lifetime number of exams appropriate for their age (based on screening every two years) and they reported having had an exam in the past two years. PRINCIPAL FINDINGS: Only 27 percent of women had the age-appropriate number of screening exams (range 16 percent-37 percent), while 59 percent of women had been screened within two years. Women were significantly more likely to adhere to screening guidelines if they reported participating with their doctor in the decision to be screened; were younger; had smaller families, higher education and income, and a recent Pap smear; reported breast problems; and lived in an area with a higher percentage of mammography facilities with reminder systems, no shortage of primary care providers, higher HMO market share, and higher screening charges. CONCLUSIONS: A small percentage of women adhere to screening guidelines, suggesting that adherence needs to become a focus of clinical, programmatic, and policy efforts.

Aged↗
PubMed1998

Purchasing population health: aligning financial incentives to improve health outcomes.

OBJECTIVE: To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis PRINCIPAL FINDINGS: The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. CONCLUSIONS: The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

Cost-Benefit Analysis↗
PubMed1998

A comparison of cardiovascular procedure use between the United States and Canada.

OBJECTIVE: To compare the relative volume and intensity of all types of cardiovascular procedures, noninvasive tests, and diagnostic imaging for all elderly individuals between the United States and the three largest Canadian provinces (Ontario, Quebec, and British Columbia) by patient age. DATA SOURCES: Service volume data for the United States for a one percent random sample of claims obtained from Medicare's National Claims History System. Data for Canada were obtained from the Ministries of Health in the three provinces representing 100 percent of the claims received by each Ministry. STUDY DESIGN: Design is a cross-sectional analysis of 1992 claims data. DATA EXTRACTION METHODS: The volume of cardiovascular services was measured in terms of the relative value units (RVUs) used in the Medicare fee schedule to calculate payments. Services were disaggregated into nine clinical categories, and comparisons were made by type of cardiovascular service and patient age. RESULTS: Overall, cardiovascular procedure RVUs per elderly beneficiary are 53 percent greater in the United States than in Canada. Differences are largest for surgical procedures such as carotid thromboendarterectomy and revascularization procedures and smallest for diagnostic imaging and noninvasive tests. The differences between the countries in the use of cardiovascular procedures increase markedly with age. For example, the United States-to-Canada ratio for PTCA use is 1.87 for persons age 65 to 69, but 7.68 for persons age 80 and older. For CABG, the ratios are 1.36 and 7.16, respectively. CONCLUSIONS: Our findings suggest that global budgets in Canada result in lower levels of cardiovascular service use among the elderly, particularly among the very aged elderly. Patient age appears to play a much more important role in determining the recipients of cardiovascular procedures in Canada than in the United States. Whether these higher rates of procedure use among the very elderly in the United States compared to Canada reflect profligate service use or contribute to improved outcomes is uncertain.

Age Factors↗
PubMed1998

Providing accurate information to women about tamoxifen therapy for breast cancer: current indications, effects, and controversies.

PURPOSE/OBJECTIVES: To address the uses of and current controversies surrounding tamoxifen therapy for the treatment and possible prevention of breast cancer so nurses may provide patients with accurate information. Factors that may hinder assimilation of information and strategies to enhance patient understanding are discussed. DATA SOURCES: Published, data-based articles and texts. DATA SYNTHESIS: The role of tamoxifen in controlling breast cancer includes adjuvant treatment for early stage breast cancer and palliative treatment of advanced disease. Investigational uses of tamoxifen include breast cancer prevention in women at high risk for the disease. Although tamoxifen has its proven benefits, confusion regarding who should take it still exists. CONCLUSIONS: Medical information as it relates to life-threatening disease often is transmitted to the public in an alarmist manner. While women still have legitimate concerns about tamoxifen use (e.g., increased risk of endometrial cancer and thromboembolic events), the benefits of this treatment for breast cancer (e.g., increased disease-free and overall survival, reduction in contralateral breast cancer) appear to far outweigh the risks. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be cognizant of issues related to tamoxifen therapy so they can assist women in making informed decisions. Unbiased communication of the facts with attention to each woman's situation can facilitate individual consideration of options in an informed manner.

Antineoplastic Agents, Hormonal↗
PubMed1998

Cancer incidence and mortality across Canada.

OBJECTIVES: This article analyses provincial and territorial patterns in incidence and mortality rates for selected cancer sites. DATA SOURCES: Cancer incidence data were obtained from the National Cancer incidence Reporting System and from the Canadian Cancer Registry. Mortality data are from the Canadian Vital Statistics Data Base. ANALYTICAL TECHNIQUES: Age-standardized incidence and mortality rates were calculated for Canada and each province/territory for men and women for major cancer sites for the 1991-1993 period. MAIN RESULTS: Geographic variations in cancer incidence and mortality rates are strongly influenced by trends in the four leading cancers: lung, colorectal, prostate and breast. Cancer rates tended to be significantly high in Quebec and Nova Scotia and significantly low in the three westernmost provinces. These patterns generally reflect provincial/territorial variations in smoking prevalence, dietary habits, and the extent of cancer control programs, such as screening.

Age Distribution↗
PubMed1998

Changing trends in melanoma incidence and mortality.

OBJECTIVES: This article analyzes trends in melanoma incidence and mortality rates. Information on sun exposure supplements these statistics. DATA SOURCES: Melanoma incidence data were obtained from the National Cancer Incidence Reporting System and from the Canadian Cancer Registry. Cancer mortality data were extracted from the Canadian Vital Statistics Data Base. Information on sun exposure is from the 1996 Sun Exposure Survey. ANALYTICAL TECHNIQUES: Incidence and mortality rates were age-standardized to the 1991 Canadian population to account for changes in the age structure of the population over time. The average annual percentage changes in age-specific rates were calculated for selected time periods. MAIN RESULTS: After years of steady increases, melanoma incidence and mortality rates have levelled off as a result of declining rates in younger age groups, and for melanoma of the trunk among men and of the leg among women. Incidence rates for men are now higher than those for women; mortality rates for men are twice as high as for women.

Adolescent↗
PubMed2003

Biochemical pathways for microvascular complications of diabetes mellitus.

OBJECTIVE: To review the current biochemical theories on how diabetes contributes to microvascular disease. DATA SOURCES: MEDLINE search (1980-June 2003) and bibliographies of articles obtained on this topic. STUDY SELECTION AND DATA EXTRACTION: Articles identified from the data sources were evaluated and those deemed relevant to this review were incorporated. DATA SYNTHESIS: The prevailing biochemical theories on how diabetes leads to microvascular disease include increased polyol (sorbitol/aldose reductase) pathway flux, production of advanced glycation end-products, generation of reactive oxygen species, and activation of diacylglycerol and protein kinase C isoforms. These pathways contribute to endothelial damage and dysfunction and may alter gene functioning. CONCLUSIONS: Each pathway, via varied and often overlapping mechanisms, contributes to altered microvascular function that leads to the development of retinopathy, neuropathy, and nephropathy, the major microvascular complications associated with diabetes.

Animals↗
PubMed2003

Dementia in community-dwelling elderly patients: A comparison of survey data, medicare claims, cognitive screening, reported symptoms, and activity limitations.

BACKGROUND AND OBJECTIVE: Population-based estimates of dementia can vary widely depending on the data source and methodology used to assess cognitive impairment. The aim of this study was to assess individual and composite measures of dementia constructed using survey and administratively collected medical data for the purpose of improving insight into inherent and avoidable biases and the interpretation of these measures. METHODS: A national survey of 5089 community-dwelling elderly persons was linked to 5 years of Medicare claims. Kappa coefficients were used to assess dementia agreement between survey, cognitive screen, and claims. Odds ratios (ORs), adjusted for age, gender, and education, were computed to assess the relation of single- and multi-source dementia variables to cognitive symptoms and activity limitations. RESULTS: Dementia prevalence among persons aged 65 and over ranged from 4.5% to 16.8% across sources. Agreement in case identification between data sources was low, ranging from 0.15 to 0.41. Despite low agreement, ORs were consistently increased for limitations in cognitively related activities/symptoms and non-overlapping dementia sources. CONCLUSION: The finding that non-overlapping dementia data sources are associated with significantly increased limitations in cognitive activities suggests that forecasts of national dementia-related resource use based on single-source data could produce serious underestimates of future need.

Activities of Daily Living↗