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PubMed2006

Ethnicity coding in a regional cancer registry and in Hospital Episode Statistics.

BACKGROUND: The collection of ethnicity information as part of cancer datasets is important for planning services and ensuring equal access, and for epidemiological studies. However, ethnicity has generally not been well recorded in cancer registries in the UK. The aim of this study was to determine the completeness of ethnicity coding in the Thames Cancer Registry (TCR) database and within the Hospital Episode Statistics (HES) data as held by the London Health Observatory, and to investigate factors associated with ethnicity being recorded. METHODS: Records for 111821 hospital admissions of London residents with a malignant cancer as a primary diagnosis between April 2002 and March 2003 and records for 25581 London residents diagnosed with cancer in 2002 were examined. Data on sex, age, cancer network of residence, deprivation, proportion of non-whites in the local authority population, and site of cancer were available. The proportion of patients in each group with a valid ethnicity code was calculated. In the TCR data proportions were also calculated adjusted for all other variables. RESULTS: Ethnicity was recorded for 90661 (81.1%) of the hospital admissions in the HES data and 5796 (22.7%) patients on the TCR database. Patients resident in areas with a higher proportion of non-white residents and the most deprived populations were more likely to have an ethnic code on the TCR database, though this pattern was not seen in the HES data. Adjustment did not materially affect the association between deprivation and ethnicity being recorded in the TCR data. CONCLUSION: There was a large difference in completeness of ethnicity between the data sources. In order to improve the level of recording in TCR data there needs to be better recording of ethnicity in sources TCR data collection staff have access to, or use of information from other sources e.g. electronic data feeds from hospitals or pathology laboratories, or HES data itself supplied directly to TCR. Efforts to collect ethnicity data should be encouraged in all healthcare settings. Future research should explore where the difficulties collecting ethnicity information lie, whether with patients, healthcare professionals or the recording procedure, and how such problems can be overcome.

Adolescent↗
PubMed2004

[Information system of the Federal Health Monitoring System. An online database offering a wide range of health information].

The information system of the Federal Health Monitoring System (http://www.gbe-bund.de) offers as an online database a wide range of coordinated health information in words and figures. High-performance software tools allow the information to be researched, analyzed flexibly, and downloaded onto the user's own PC for subsequent processing. At present, the core of the information system represents more than 650 million data from more than 100 data sources, combined in sensible indicators. Clearly arranged diagrams, easy-to-understand texts, and precise definitions complete the offer. Documentations contain additional information on more than 200 data sources, features of surveys, methodological questions of surveys, and contact persons.

Databases as Topic↗
PubMed1997

The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration.

OBJECTIVES: To identify all patients with diabetes in a community using electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care. DESIGN: Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics, all encashed prescriptions for diabetes related drugs and monitoring equipment, all patients discharged from hospital, patients attending a mobile unit for eye screening, and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry database. Diabetes registers from primary care were from a random sample of eight Tayside general practices. A detailed manual study of relevant records for the 35,144 patients registered with these eight general practices allowed for validation of the case ascertainment. SETTING: Tayside region of Scotland, population 391,274 on 1 January 1996. MAIN OUTCOME MEASURES: Prevalence of diabetes; population of patients identified by different data sources; sensitivity and positive predictive value of ascertainment methods. RESULTS: Electronic record linkage identified 7596 diabetic patients, giving a prevalence of known diabetes of 1.94% (0.21% insulin dependent diabetes, 1.73% non-insulin dependent): 63% of patients had attended hospital diabetes clinics, 68% had encashed diabetes related prescriptions, 72% had attended the mobile eye screening unit, and 48% had biochemical results diagnostic of diabetes. A further 701 patients had isolated hyperglycaemia (plasma glucose > 11.1 mmol/l) but were not considered diabetic by general practitioners. Validation against the eight general practices (636 diabetic patients) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes. General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98. CONCLUSIONS: Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18% of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes.

Diabetes Mellitus↗
PubMed2005

Pathophysiology of mifepristone-induced septic shock due to Clostridium sordellii.

OBJECTIVE: To explain the role of mifepristone in medical abortions that results in fulminant and lethal septic shock due to Clostridium sordellii. DATA SOURCES: MEDLINE, PubMed, and Google Scholar databases were searched (1984-March 2005). Key search terms were mifepristone, RU38486, RU486, Mifeprex, medical abortion, septic shock, innate immune system, cytokines, and Clostridium sordellii. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and all information deemed relevant was included for the information related to the development of the understanding of the pathophysiology of mifepristone-induced septic shock due to C. sordellii. DATA SYNTHESIS: The mechanisms of action of mifepristone were incorporated into the pathophysiology of septic shock due to C. sordellii. Mifepristone, by blocking both progesterone and glucocorticoid receptors, interferes with the controlled release and functioning of cortisol and cytokines. Failure of physiologically controlled cortisol and cytokine responses results in an impaired innate immune system that results in disintegration of the body's defense system necessary to prevent the endometrial spread of C. sordellii infection. The abnormal cortisol and cytokine responses due to mifepristone coupled to the release of potent exotoxins and an endotoxin from C. sordellii are the major contributors to the rapid development of lethal septic shock. CONCLUSIONS: Theoretically, it appears that the mechanisms of mifepristone action favor the development of infection that leads to septic shock and intensifies the actions of multiple inflammatory cytokines, resulting in fulminant, lethal septic shock.

Abortifacient Agents↗
PubMed2005

Proton pump inhibitor formulary considerations in the acutely ill. Part 1: Pharmacology, pharmacodynamics, and available formulations.

OBJECTIVE: To review important proton pump inhibitor (PPI) pharmacologic, pharmacokinetic, and pharmacodynamic principles in acutely ill patients, compare PPI formulation options for patients unable to swallow a tablet or capsule, and provide clinicians with guidance when making hospital formulary decisions with this class of agents. DATA SOURCES: MEDLINE (1966-May 2005) and the Cochrane Library databases were searched using the key words proton pump inhibitor, acid suppression, peptic ulcer disease, gastrointestinal bleeding, stress ulcer prophylaxis, and critical illness. Bibliographies of cited references were reviewed, and a manual search of abstracts from recent gastroenterology, critical care, and surgery scientific meetings was completed. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included for this review. DATA SYNTHESIS: PPIs have become a mainstay for acute acid suppression in hospitalized patients over other therapeutic options. Various commercially available PPI products are available for administration, either enterally or parenterally, to patients unable to swallow a tablet or capsule. Newer oral PPI formulations offer numerous advantages over older products. The results of studies comparing the pharmacokinetics and pharmacodynamics of different PPI dosage forms and routes of administration are among the factors to consider when making formulary decisions. CONCLUSIONS: While the introduction of new PPI products has expanded the therapeutic options for acid suppression in acutely ill patients, a number of unresolved questions remain surrounding the interchangeability of these products, the clinical significance of one PPI formulation over the other, and how oral/enteral PPI therapy should be used as step-down therapy after parenteral PPI therapy.

Administration, Oral↗
PubMed2002

Data integration in the evaluation of juvenile justice education.

This article discusses the Juvenile Justice Educational Enhancement Program's evaluation of juvenile justice education through the integration of multiple data sources. Validation of best practices and the corresponding effect of these practices on community reintegration require the development of a comprehensive database of program-level and individual-level indicators from several sources. These sources include the Florida Department of Education, the Florida Department of Juvenile Justice, the Florida Department of Law Enforcement, the Florida Department of Corrections, and the Juvenile Justice Educational Enhancement Program's own educational quality assurance and pre-/posttest data. This article examines the methodological, political, and bureaucratic obstacles encountered in this effort. Evaluation research analyses are also explored with an emphasis on the meaning of outcome measures relative to causal issues of time order, the modeling of events, and analytic strategy. The article provides a framework for future juvenile justice educational evaluation and a critical examination of problems encountered in integrating data sources for the purpose of outcome evaluation.

Criminal Law↗
PubMed2002

Where have all the young girls gone or where do all the men come from? Change and lack of change in demographic characteristics of the norwegian heroin user population.

A rough estimate indicates that women amount to one third of the heroin user population in Norway. However, among the youngest users females account and have accounted for a larger proportion. Given this greater representation of females in the younger age groups one would expect that the gender difference in the general population of users would be reduced over time due to a cohort effect. However, the ratio of male to female users has remained stable. The prevailing explanation for this stability is based on the claim that women are more likely to overcome their abuse. This paper addresses both the basis for the assumption of a missing cohort effect and examines an alternative explanation linked to the way into abuse rather than the way out. The study primarily draws upon two distinct data sources. The first body of material consists of interviews carried out in the period 1993-1997 with people attending the only needle exchange service in Oslo. The second data source consists of police records, which provide the number of persons arrested each year in the period 1984-1997 for using, possessing or selling heroin distributed by age and gender. We find that the age of injection debut has increased and that this is especially true for male users. Applying a simple quantitative model, the effect a change in recruitment may have on the male-to-female ratio is analysed. The results indicate that a higher debut age may have contributed to stabilizing the gender gap. The finding suggests that more research is needed on the conditions of recruitment in order to better predict the future population demographics and to avoid hasty and incorrect conclusions.

Adult↗
PubMed1995

Estimated societal costs of assertive community mental health care.

OBJECTIVE: The study used a societal costs model to estimate costs of assertive community treatment for persons with severe mental illness. METHODS: Resource use and cost data were collected for mental health, health, social, and law enforcement, and other maintenance services and family services for 94 clients enrolled in a mobile community treatment program in Madison, Wisconsin. Data sources included self-reports of clients and family members, private and public agency records, and insurance claims files. To make more precise estimates, outcome definitions were broadened, data sources were cross-validated, and prices of services were calculated independently of agencies' charges for such services. RESULTS: Average societal costs for participants in the study were estimated at $23,061 in 1988 ($29,965 in 1994 dollars). Use of a less sophisticated model with less careful costing methods would have resulted in an estimated average cost at least 30 percent lower. Maintenance costs (cash payments from government programs, subsidies, and in-kind services) were the largest cost component, followed by mental health treatment, family burden, indirect treatment, and law enforcement. Most of the financing for these services came from the public sector (85 percent). CONCLUSIONS: Accurate, reliable, and consistent measurement of societal costs will aid in the complex task of rationing fixed health and mental health care budgets.

Adult↗
PubMed2003

Certainties and uncertainties of land cover statistics in China.

Vegetation or land cover maps have been made directly or indirectly available for the entire territory of China. The certainties and uncertainties of land cover statistics were analyzed by comparing three data sources: China's Vegetation Map, IGPB DISCover, and University of Maryland Product. Great similarities in the statistics of 7 aggregated land cover types were found among the three data sources,particularly between the two global land cover maps. The per-pixel agreement between any 2 of 3 maps was between 38.0%-51.4%; the per-pixel agreement among all three maps was only 27.1%. Certainties were found in regions where vegetation types are typical and human land use practice is relatively homogenous; the uncertainties occurred to either vegetation transition zones or regions where land cover types and land use practice are relatively diversified. Systematic and multidisciplinary efforts are necessary to promote accurate mapping of nationwide land cover types in China. Intensive efforts should be made in regions where uncertainties of land cover information are found.

China↗
PubMed2006

Residents in trouble: an in-depth assessment of the 25-year experience of a single family medicine residency.

BACKGROUND AND OBJECTIVES: Graduate medical education program directors struggle with resident trainees who develop problems in academic and personal spheres leading to probation, resignation, or termination of training. These "residents in trouble" generate a disproportionate amount of work and can demoralize faculty and residents. Only two prior studies have identified the prevalence of residents in trouble. In both studies, the prevalence was based on nonvalidated program director self-report. In contrast, our study uses a review of primary data sources to describe the prevalence, types of problems, remediation methods, and outcomes for residents in trouble over the 25-year experience of a residency program. METHODS: Five primary data sources were reviewed for every trainee who was enrolled from 1978-2003 at the David Grant Medical Center Family Medicine Residency, looking for any of eight types of occurrences previously identified in the literature as marking a resident in trouble. RESULTS: Over this 25-year period, 230 residents entered training and 209 graduated. The prevalence of residents in trouble was 9.1%. The types of problems encountered included divorce, psychiatric illness, substance abuse, attitudinal problems, interpersonal conflict, excessive patient complaints, and insufficient knowledge. A variety of remediation approaches were used, and 90% of the residents in trouble graduated. CONCLUSIONS: The 9.1% provides a point of comparison for program directors to know if their residency has a disproportionate rate of problems requiring organizational reform or if they are dealing with the normative experience of a training program. Our program's experience supports five suggestions for the management of residents in trouble.

California↗
PubMed2005

Hyperglycemia in the hospital setting: the case for improved control among non-diabetics.

OBJECTIVE: To review studies on the role of hyperglycemia in acutely ill adults, regardless of diabetes diagnosis, and the impact of glucose control on health outcomes. DATA SOURCES: Searches on Ovid MEDLINE, Ovid Evidence-Based Medicine (EBM), and PubMed MEDLINE, limited to articles written in English, trials conducted on adult subjects, and material published between 1994 and April 2004. Search words included the major MeSH term hyperglycemia and title words glucose, hyperglycemia/hyperglycemic, or insulin therapy, with text words admission, hospitalized, in-hospital, or inpatient. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: Hyperglycemia, even in patients without diabetes, has been shown to be detrimental among inpatients in medical and surgical units, as well as in critical care. A review of 25 outcomes studies indicated that the majority of research on this topic used retrospective or prospective cohort designs; only 2 were conducted as randomized controlled studies. In general, the findings demonstrated negative impact on outcomes among various patient populations with hyperglycemia including increased lengths of stay, health complications, utilization of resources, and risk of mortality. CONCLUSIONS: Studies report that hyperglycemia is a common but detrimental condition and that better control in the hospital setting decreases short- and long-term risk of mortality, illness complications, hospital lengths of stay, and healthcare costs. Increased efforts to treat hyperglycemia and screen for diabetes are needed in the hospital setting. Future studies on cost-effective approaches to glucose control are recommended.

Cardiovascular Diseases↗
PubMed2005

Proton pump inhibitor formulary considerations in the acutely ill. Part 2: Clinical efficacy, safety, and economics.

OBJECTIVE: To review, using an evidence-based approach, the clinical efficacy, safety, and cost-effectiveness of proton pump inhibitors (PPIs) for treatment of common acid peptic disorders in the acutely ill and provide clinicians with guidance when making hospital formulary decisions with this class of agents. DATA SOURCES: MEDLINE (1966-May 2005) and the Cochrane Library databases were searched using the key words proton pump inhibitor, acid suppression, peptic ulcer disease, gastrointestinal bleeding, stress ulcer prophylaxis, critical care, safety, and cost-effectiveness. Bibliographies of cited references were reviewed, and a manual search of abstracts from recent gastroenterology, critical care, and surgery scientific meetings was completed. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included for this review. DATA SYNTHESIS: PPIs have become a mainstay for acute acid suppression in hospitalized patients. Various commercially available PPI products are available either enterally or parenterally for administration to patients unable to swallow a tablet or capsule. The results of studies comparing the clinical efficacy of different PPI dosage forms and routes of administration, safety considerations, and cost-effectiveness analyses are among the factors to consider when making formulary decisions for this class of drugs. CONCLUSIONS: While the introduction of new PPI products has expanded the therapeutic options for acid suppression in acutely ill patients, a number of unresolved questions remain surrounding the interchangeability of these products, the clinical significance of one PPI formulation over the other, and how oral/enteral therapy should be used as step-down therapy after parenteral therapy.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1999

Health status of a population of infants born before 26 weeks gestation derived from routine data collected between 21 and 27 months post-delivery.

UNLABELLED: This retrospective study was designed: (a) to determine the extent to which routine data sources in the UK can provide data relating to the later health status of selected groups of infants; and (b) to use such an approach to describe the outcome of a geographically defined population of infants born before 26 weeks gestation. All infants of less than 26 weeks gestation admitted for neonatal intensive care during the period 1/1/91 and 31/12/93 whose mother's address at the time of birth was within the boundaries of the Trent Health Region were included. Health status was assessed against a previously described simple scheme and using information from existing sources only. During the 3-year period 249 infants of less than 26 weeks gestation were admitted for intensive care. Of these 66 (26.5%) survived to be discharged from the neonatal service. A further seven infants died before the age of 2 years. Of the remaining 59 four were lost to follow up (three could not be traced; one was living abroad). Of the 55 infants reviewed, 36 demonstrated no features, pre-defined in the classification scheme, of severe disability. However, only 30 children appeared to be considered entirely normal. CONCLUSION: Infants born before 26 weeks gestation and admitted for neonatal intensive care had, approximately, a 12% chance of normal survival to 2 years. A slightly smaller proportion of infants survived with significant disability. Existing routine data sources could be adapted to provide useful public health information about the outcome of 'high risk' groups of infants.

Cerebral Palsy↗
PubMed2004

Pharmacologic prevention or delay of type 2 diabetes mellitus.

OBJECTIVE: To evaluate the current data on pharmacologic interventions intended to prevent or delay the onset of type 2 diabetes mellitus. DATA SOURCES: Searches of MEDLINE (1966-July 2002) and an extensive manual review of journals were performed using the key search terms diabetes mellitus, metformin, acarbose, troglitazone, orlistat, nateglinide, risk reduction, and prevention. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included for this review. Randomized controlled trials and meta-analyses were included if the primary outcome measure was prevention of diabetes and/or change in the rate of progression to diabetes. DATA SYNTHESIS: Type 2 diabetes mellitus is a growing epidemic. Major risk factors include obesity, impaired glucose tolerance, and impaired fasting glucose. Complications of diabetes result in significant morbidity and mortality and are a substantial public health issue. Four randomized, blinded, controlled trials have assessed the efficacy of different medications, including metformin, troglitazone, acarbose, and orlistat, at decreasing the risk of progression to diabetes in patients at risk for developing diabetes. All of these agents decreased the risk of progression to diabetes. CONCLUSIONS: Metformin, troglitazone, acarbose, and orlistat have been shown to decrease the risk of progression to diabetes in patients at risk for developing diabetes. Other questions that address issues such as identifying target populations, cost-effectiveness, and screening strategies must be answered to more fully define the place of pharmacologic therapy to prevent or delay diabetes.

Acarbose↗
PubMed1999

Epidemiologists and adverse event data--a challenge to the field.

Spontaneous adverse event reports, albeit biased and incomplete data, remain very important and, frequently, are the sole data source to rely on during the postmarketing phase for regulatory decision making. However, little progress has been made in the past decade to improve the utility of these essential data. Further research that helps to improve our understanding of the extent and characteristics of adverse event reporting should be done to ensure the maximum, appropriate utilization of this highly cost-efficient data source. In addition, the authors challenge that research can and should be done to advance our understanding of the behaviour and motivations of those who report adverse events so as to improve the quality and the quantity of meaningful spontaneous adverse event reports.

Journal Article↗
PubMed1990

Comparability of reasons for cesarean sections in patient records and mothers' interviews.

Reasons for cesarean sections from three different data sources were compared. One hundred mothers were interviewed, their patient records were read, and the discharge diagnoses were noted. In about 70% of cases at least two of the data sources gave similar reasons for cesarean section, but when all three sources were compared, in only one-third was information similar. These figures cast doubt on the utility of recorded indications in studying reasons for cesarean sections.

Adult↗
PubMed1989

Effects of curriculum-based measurement on teachers' instructional planning.

This study assessed the effects of curriculum-based measurement (CBM) on teachers' instructional planning. Subjects were 30 teachers, assigned randomly to a computer-assisted CBM group, a noncomputer CBM group, and a contrast group. In the CBM groups, teachers specified 15-week reading goals, established CBM systems to measure student progress toward goals at least twice weekly, and systematically evaluated those data bases to determine when instructional modifications were necessary. Contrast teachers monitored student progress toward Individualized Education Program (IEP) goals as they wished and were encouraged to develop instructional programs as necessary. At the end of a 12- to 15-week implementation period, teachers completed a questionnaire with reference to one randomly selected pupil. Analyses of variance indicated no difference between the CBM groups. However, compared to the contrast group, CBM teachers (a) used more specific, acceptable goals; (b) were less optimistic about goal attainment; (c) cited more objective and frequent data sources for determining the adequacy of student progress and for deciding whether program modifications were necessary; and (d) modified student programs more frequently. Questionnaire responses were correlated with verifiable data sources, and results generally supported the usefulness of the self-report information. Implications for special education research and practice are discussed.

Adolescent↗
PubMed1999

Assessing the effects of welfare reform policies on reproductive and infant health.

OBJECTIVES: The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. METHODS: The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. RESULTS: State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions. CONCLUSIONS: Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.

Family Planning Services↗