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PubMedDate not supplied

Agreement between patient self-report and a Veterans Affairs national pharmacy database for identifying recent exposures to antibiotics.

PURPOSE: The dramatic rise in antibiotic drug resistance among community pathogens has stimulated interest in the epidemiological relationship between antibiotic exposure and drug resistance. In assessing the strength of this relationship, studies are hampered by the lack of data on the accuracy of subject self-report of antibiotic exposure. The authors compared self-report with pharmacy dispensing data to determine the accuracy of self-reported antibiotic exposure. METHODS: The study design was a cross-sectional survey of veterans seen at the Philadelphia Veterans Affairs (VA) Medical Center in 1999 and 2000. Subjects reported exposures to antibiotics, antihypertensive drugs and nonsteroidal anti-inflammatory drugs through a structured telephone interview. The instrument included open-ended questions, condition-specific prompts and drug-specific prompts. Subject responses were linked to a national VA pharmacy database that served as the reference standard for evaluating self-reported exposures. RESULTS: The authors found that the sensitivity of self-report of antibiotic exposure increased with increasing use of prompts. A comprehensive assessment of antibiotic exposure identified 73% of antibiotic exposures, compared to 73% of antihypertensive drug exposures and 92% of nonsteroidal anti-inflammatory drug exposures. CONCLUSIONS: Assessment of antibiotic exposure appears to be comparable to assessment of other chronic and episodic drugs. Multistep assessment of exposure improves the sensitivity of assessment.

Adolescent↗
PubMed2000

IMGT, the international ImMunoGeneTics database.

IMGT, the international ImMunoGeneTics database (http://imgt.cines. fr:8104 ), is a high-quality integrated database specialising in Immunoglobulins (Ig), T cell Receptors (TcR) and Major Histocompatibility Complex (MHC) molecules of all vertebrate species, created in 1989 by Marie-Paule Lefranc, Université Montpellier II, CNRS, Montpellier, France (lefranc@ligm.igh.cnrs.fr ). At present, IMGT includes two databases: IMGT/LIGM-DB, a comprehensive database of Ig and TcR from human and other vertebrates, with translation for fully annotated sequences, and IMGT/HLA-DB, a database of the human MHC referred to as HLA (Human Leucocyte Antigens). The IMGT server provides a common access to expertized genomic, proteomic, structural and polymorphic data of Ig and TcR molecules of all vertebrates. By its high quality and its easy data distribution, IMGT has important implications in medical research (repertoire in autoimmune diseases, AIDS, leukemias, lymphomas), therapeutic approaches (antibody engineering), genome diversity and genome evolution studies. IMGT is freely available at http://imgt.cines.fr:8104. The IMGT Index is provided at the IMGT Marie-Paule page (http://imgt.cines.fr:8104/textes/IMGTindex.html).

Amino Acid Sequence↗
PubMed2001

Economic analysis of treatment of functional dyspepsia. An assessment of the quality of published studies.

OBJECTIVES: The objective of this study was to assess the quality of economic analysis studies published in the medical and economical literature assessing the clinical management of functional dyspepsia. METHODS: Bibliographic search in the main biomedical databases, in articles from bibliographic references, health technology assessment reports, and in gray literature. A specific protocol with economic and clinical items was designed for the evaluation. RESULTS: Overall, 18 of 162 studies met the inclusion criteria for the assessment. The compared treatment options were very diverse. The main methodologic deficiencies were in perspective of analysis, inclusion of indirect costs, and sources of clinical information. CONCLUSIONS: Specific checklists with clinical and economical items may help to better assess the quality of economic analysis in the field of functional dyspepsia. The methodologic rigor in the application of economic analysis techniques, as well as the use of appropriate clinical outcome measures, is essential to guarantee the reproducibility of the studies.

Bibliometrics↗
PubMed2005

Predicting the oncogenicity of missense mutations reported in the International Agency for Cancer Research (IARC) mutation database on p53.

Many mutation databases, comprising thousands of reported mutations, are available. Often the clinical significance of the reported mutations is unknown. In this study we developed an algorithm that allows prediction of the clinical significance of missense mutations reported in a mutation database. Nonsense mutations are used as a referent group for this assessment. We used the International Association for Research on Cancer (IARC) mutation database on TP53 to implement the algorithm. First, on the basis of published data [Nachman MW, Crowell SL. 2000. Genetics 156:297-304], we ascribed mutation rates to every single nucleotide substitution (SNS) in the core domain of the TP53 gene. Second, for every possible SNS we computed the expected number of missense mutations, under the assumption that missense mutations are as oncogenic as nonsense ones. The natural logarithm of the ratio of the observed to the expected number of missense mutations (LR) was used as a quantitative measure of oncogenicity (i.e., the ability of a mutation to produce cancer). We estimated the relative oncogenicity of all missense mutations reported in the IARC p53 mutation database, and constructed a profile of oncogenicity of the missense mutations along the DNA-binding region of p53.

Algorithms↗
PubMed2005

A Distributed Database and a New Application for the DRG System.

The article presents a new solution for the implementation of the DRG classifying system used in Romania to finance hospitals. The new solution implies two proposals. The first one refers to the use of a fragmented and distributed database at level of each hospital, and the second refers to the management and the viewing of this database by means of an on-line application implemented in Java. The solution proposes that the distributed database should be managed by two powerful tools, meaning Oracle8 Server and Net8. Different types of users are proposed, each type with his own rights for managing and viewing the database. Excepting local users who use only their local database, there are also global users from National DRG Bureau who can see data from all local databases, at any time. This solution is more efficient, secure and modern, than the one used now.

Computer Communication Networks↗
PubMed2003

Structure of the hypothetical protein AQ_1354 from Aquifex aeolicus.

The crystal structure of a hypothetical protein AQ_1354 (gi 2983779) from the hyperthermophilic bacteria Aquifex aeolicus has been determined using X-ray crystallography. As found in many structural genomics studies, this protein is not associated with any known function based on its amino-acid sequence. PSI-BLAST analysis against a non-redundant sequence database gave 68 similar sequences referred to as 'conserved hypothetical proteins' from the uncharacterized protein family UPF0054 (accession No. PF02310). Crystallographic analysis revealed that the overall fold of this protein consists of one central alpha-helix surrounded by a four-stranded beta-sheet and four other alpha-helices. Structure-based homology analysis with DALI revealed that the structure has a moderate to good resemblance to metal-dependent proteinases such as collagenases and gelatinases, thus suggesting its possible molecular function. However, experimental tests for collagenase and gelatinase-type function show no detectable activity under standard assay conditions. Therefore, we suggest either that the members of the UPF0054 family have a similar fold but different biochemical functions to those of collagenases and gelatinases or that they have a similar function but perform it under different conditions.

Amino Acid Sequence↗
PubMed1997

[Review of the data on incidence of invasive disease and meningitis caused by Haemophilus influenzae in children under 5 years of age in Spain].

OBJECTIVE: The object of this study was to summarize the available information on the incidence of invasive disease and meningitis caused by Haemophilus influenzae in Spain from 1985 to 1995, evaluating potential geographic differences. METHODS: Systematic and exhaustive literature searches of computerized databases, manual review of obtained references, revision of relevant Spanish journals and proceedings of congresses and direct consultation with experts were carried out. Yearly incidence rates were estimated per 100,000 children less than 5 years of age, by year and geographical region. RESULTS: We encountered 16 studies, one covering the entire Spanish population and the rest limited to Catalonia, the Basque Country, the Valencian Community, Andalucia, Navarra or the Community of Madrid. In 1994, the incidence of invasive H. influenzae disease varied from 8.4 cases per 100,000 children under 5 years of age in Navarra to 26.3 cases per 100,000 children under 5 years of age in the Basque Country. CONCLUSIONS: Available data do not permit the nationwide estimation of the incidence rate, although it is possible to appreciate that important geographic differences exist. It is remarkable the lack of specific information for the majority of Spanish regions, as well as the lack of data to assess temporal trends.

Child, Preschool↗
PubMed2000

Interpretation of echocardiographic measurements: a call for standardization.

BACKGROUND: Although echocardiography is used extensively in clinical medicine, guidelines for quantitative interpretation of echocardiographic measurements are unavailable. The goals of this investigation were to provide an overview of scientific standards for formulating reference values, with clinical chemistry used as a model, to evaluate published echocardiographic reference limits, to survey clinical echocardiography laboratories regarding their interpretation of echocardiographic measurements, and to provide recommendations for improving the interpretation and reporting of echocardiographic measurements. METHODS AND RESULTS: We reviewed the original reports of the International Federation of Clinical Chemistry on guidelines for formulating reference values. We obtained published reports on echocardiographic reference limits through searches of electronic databases supplemented by a manual search of relevant bibliographies. We also surveyed echocardiographic laboratories in 35 adult acute-care hospitals in Eastern Massachusetts. Studies on echocardiographic reference values were evaluated with the use of guidelines from clinical chemistry. Responses from the 29 participating echocardiographic laboratories were evaluated for their practice of quantitative echocardiographic interpretation. There is considerable heterogeneity in the echocardiographic reference values available in the literature. There is also a lack of agreement in the literature and among echocardiographers regarding the partitioning of reference values (by sex, ethnicity, or age), the anthropometric measure to be used for indexation, and the choice of cut-points for categorizing values within the abnormal range. CONCLUSIONS: We advocate that echocardiographic reference limits be standardized and a consensus generated regarding the partitioning of reference limits and the indexation of echocardiographic measurements. Such measures can aid in quantitative echocardiographic interpretation and render the results more scientific and consistent.

Adolescent↗
PubMed1996

Does the normal contralateral wrist provide the best reference for X-ray film measurements of the pathologic wrist?

This study compares in normal subjects the variability of wrist x-ray film measurements between the right and left sides with the variability of the distribution of those measurements within the population. Additional purposes were to evaluate possible differences of these measurements according to sex, age, side, and hand dominance. The variability when comparing both sides was found to be statistically less for the carpal height, radiolunate, scapholunate, and capitolunate angles than within the whole group of subjects, and for those measurements, there was a high correlation (r > .88) between the right and left sides. In addition, the carpal height and the carporadial ratios were lower and the capitolunate angle was higher in women than in men. There was also a significant decrease of the scapholunate angle in older individuals. The clinical implication of these findings is that in unilateral wrist diseases, the normal wrist should be used to provide the reference values of the carpal height and of the carpal angles on profile x-ray films. However, for the radial inclination and palmar tilt of the distal radius and for the ulnar variance, the normal side does not provide a better reference than normal values obtained from databases.

Adult↗
PubMed2006

Coronary heart disease policy models: a systematic review.

BACKGROUND: The prevention and treatment of coronary heart disease (CHD) is complex. A variety of models have therefore been developed to try and explain past trends and predict future possibilities. The aim of this systematic review was to evaluate the strengths and limitations of existing CHD policy models. METHODS: A search strategy was developed, piloted and run in MEDLINE and EMBASE electronic databases, supplemented by manually searching reference lists of relevant articles and reviews. Two reviewers independently checked the papers for inclusion and appraisal. All CHD modelling studies were included which addressed a defined population and reported on one or more key outcomes (deaths prevented, life years gained, mortality, incidence, prevalence, disability or cost of treatment). RESULTS: In total, 75 articles describing 42 models were included; 12 (29%) of the 42 models were micro-simulation, 8 (19%) cell-based, and 8 (19%) life table analyses, while 14 (33%) used other modelling methods. Outcomes most commonly reported were cost-effectiveness (36%), numbers of deaths prevented (33%), life-years gained (23%) or CHD incidence (23%). Among the 42 models, 29 (69%) included one or more risk factors for primary prevention, while 8 (19%) just considered CHD treatments. Only 5 (12%) were comprehensive, considering both risk factors and treatments. The six best-developed models are summarised in this paper, all are considered in detail in the appendices. CONCLUSION: Existing CHD policy models vary widely in their depth, breadth, quality, utility and versatility. Few models have been calibrated against observed data, replicated in different settings or adequately validated. Before being accepted as a policy aid, any CHD model should provide an explicit statement of its aims, assumptions, outputs, strengths and limitations.

Coronary Disease↗
PubMed2000

The Cochrane review of bed rest for acute low back pain and sciatica.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to rest in bed for patients with acute low back pain (LBP) or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, and reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Nine trials with a total of 1435 patients were included. Four trials compared bed rest with advice to stay active, and the overall results were heterogeneous. Overall, results from two high-quality studies indicate no difference in pain intensity at the 3-week follow-up (standardized mean difference 0.0; 95% confidence interval [CI] -0.3, 0.2]), and a small difference in functional status in favor of staying active (weighted mean difference 3.2 [on a 0-100 scale] 95% CI 0.6, 5.8). In two high-quality trials no differences were reported in pain intensity between 2-3 days of bed rest and 7 days of bed rest. In another two high-quality trials, no differences were found between bed rest and exercises in pain intensity or functional status. CONCLUSION: Bed rest compared with advice to stay active at best has no effect, and at worst may have slightly harmful effects on LBP. There is not an important difference in the effects of bed rest compared with exercises in the treatment of acute low back pain, or 7 days compared with 2-3 days of bed rest in patients with low back pain of different durations with and without radiating pain.

Activities of Daily Living↗
PubMed2005

Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis.

OBJECTIVE: To review the effects of monotherapy with alpha-glucosidase inhibitors (AGIs) for patients with type 2 diabetes, with respect to mortality, morbidity, glycemic control, insulin levels, plasma lipids, body weight, and side effects. RESEARCH DESIGN AND METHODS: We systematically searched the Cochrane Central register of Controlled Trials, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, and reference lists, and we contacted experts and manufacturers. Inclusion criteria were randomized controlled trials of at least 12 weeks' duration, AGI monotherapy compared with any intervention, and one of the following outcome measures: mortality, morbidity, GHb, blood glucose, lipids, insulin levels, body weight, or side effects. Two independent reviewers assessed all abstracts, extracted all data, and assessed quality. We contacted all authors for data clarification. Continuous data were expressed as weighted mean differences and analyzed with a random-effects model. Possible influences of study characteristics and quality were assessed in sensitivity and meta-regression analyses. RESULTS: Forty-one studies were included in the review (30 acarbose, 7 miglitol, 1 voglibose, and 3 combined), and heterogeneity was limited. We found no evidence for an effect on mortality or morbidity. Compared with placebo, AGIs had a beneficial effect on GHb (acarbose -0.77%; miglitol -0.68%), fasting and postload blood glucose and postload insulin. With acarbose dosages higher than 50 mg t.i.d., the effect on GHb was the same, but the occurrence of side effects increased. Acarbose decreased the BMI by 0.17 kg/m2 (95% CI 0.08-0.26). None of the AGIs had an effect on plasma lipids. Compared with sulfonylurea, AGIs seemed inferior with respect to glycemic control, but they reduced fasting and postload insulin levels. For comparisons with other agents, little data were available. CONCLUSIONS: We found no evidence for an effect on mortality or morbidity. AGIs have clear beneficial effects on glycemic control and postload insulin levels but not on plasma lipids. There is no need for dosages higher than 50 mg acarbose t.i.d.

Blood Glucose↗
PubMed1995

Operational aspects of Quality-of-Life Assessment. Choosing the right instrument.

In assessing quality of life, the most important goal is to develop a strategy that produces useable and useful information for decision making. Assessment design is complex, and whether an assessment is developed from scratch, or 1 or more portions of existing instruments are adapted, the focus must be on the quality of the theoretical and operational elements of the particular line of inquiry and its environment. The necessary and most often discussed focus on the theoretical dimensions of validity, reliability and responsiveness is not sufficient to insure that the data are of the requisite high quality. There is also a need, almost universally given little attention in the literature, to look at operational aspects, such as design, format, flow, appearance, and response-stimulus, of each assessment instrument. Searching for guidance in the quality-of-life (QOL) literature remains a challenge even with computers, modems, keywords, static guidebooks and bibliographic systems. The On-Line Guide to Quality-of-Life Assessments (OLGA) is presented as a personal computer-based system that is updated 3 times a year to provide QOL researchers and assessment developers with 2 databases: assessments providing full descriptions and contact information; and references providing fully keyed citations to the assessment use literature. These databases are made more useful by decision-logical programs that identify relevant assessments and supporting research literature. OLGA can thus save time and other resources by helping investigators concentrate on the most relevant elements of the existing literature. This focus will assist them in avoiding the problems of ending up with the right answers to the wrong questions.

Health Status↗
PubMed1991

Structure prediction and modelling.

Protein structure prediction from sequence remains a major goal in molecular biology. The methods described in this review concentrate on deriving structural information through the detection of similarities between a test sequence and a database of known structures. Such methods are often referred to as knowledge-based strategies reflecting the use of a structural database in the analyses. The past year has seen considerable advances in both the development of automated procedures and their application to protein sequences of outstanding biological interest.

Algorithms↗
PubMedDate not supplied

The development and application of a surgical database.

Since 1971, the members of a department of surgery in a staff model HMO have maintained a surgical database using a microcomputer. The reasons for this effort are discussed with specific reference to the ethical requirements of such a database. The system design lends itself to any type of practice. Illustrative examples are given of the types of data easily obtained. The role this information plays in the practice of surgery is discussed. This approach is one way to address issues of clinical decision-making, quality control and research.

Computer Systems↗
PubMedDate not supplied

Finding the evidence.

Powerful new electronic resources have greatly enhanced the ability of physicians to find current evidence to answer clinical questions. CD-ROM databases and World Wide Web access via the Internet provide convenient, up-to-date, easily searchable reference material for practicing physicians. The MEDLINE database is now available free of charge through Internet Grateful Med and PubMed on the Internet. Physicians can focus a literature search to retrieve studies that use methodology consistent with good medical evidence. Once the citations are in hand, physicians have several options to retrieve the full text of the relevant articles.

CD-ROM↗
PubMed2004

Evaluation of drug interaction software to identify alerts for transplant medications.

BACKGROUND: The ability of computerized physician order entry (CPOE) systems to identify clinically significant drug interactions is dependent upon the integrity of the drug information populating the software. A CPOE system with incomplete or inaccurate drug information will fail to identify clinically important drug interactions and, therefore, fail to reduce preventable adverse drug events (pADEs). OBJECTIVE: To evaluate, from the prescribers' perspective, the ability of a common drug interaction database to identify clinically important drug interactions involving drugs used in transplantation. METHODS: The clinical significance of drug interactions involving 5 transplant drugs was evaluated by an expert panel to determine whether alerts should be generated for physicians not involved in the transplant at the time of order entry. Drug interactions included in the analysis were generated from the expert panel, a common drug interaction database, and 2 standard drug interaction references. Responses on the clinical significance were used to calculate the sensitivity, specificity, and positive and negative predictive values for each severity setting of a common electronic drug interaction database. RESULTS: Overall, the database failed to identify approximately 70% of interactions considered significant by the expert panel. Of the alerts that were generated, >85% were considered clinically significant. The database was most deficient in identifying interactions resulting from additive toxicity. CONCLUSIONS: To expect a decrease in pADEs caused by drug interactions, the information used to populate CPOE systems must be validated. Establishing consistency and integrity of this information may be a future role for pharmacists.

Databases as Topic↗
PubMed2006

Risk factors for hypospadias.

Despite being one of the most common congenital defects in boys, the etiology of hypospadias remains largely unknown. In this case-referent study, we evaluated a wide spectrum of potential risk factors for hypospadias. Cases were identified from the hospital information system, and referents were recruited through the parents of the cases. Both parents of cases and referents completed written questionnaires that they received through the mail. Logistic regression analyses were used to assess the independent contribution of different factors to the risk of hypospadias. The final database included 583 cases and 251 referents. Hypospadias more often occurred in children whose father had hypospadias (OR=9.7; 95%CI: 1.3-74.0) and in children with a low birth weight (OR=2.3; 95%CI: 1.2-4.2). Indications for elevated risks were found when mothers were DES-daughters (OR=3.5; 95%CI: 0.8-15.6), fathers were subfertile (OR=1.8; 95%CI: 0.7-4.5), the parents had undergone fertility treatment (OR=2.3; 95%CI: 0.9-5.8), and in twin or triplet pregnancies (OR=2.0; 95%CI: 0.8-5.1). Maternal use of iron supplements (OR=2.2; 95%CI: 0.8-6.0), maternal smoking (OR=1.5; 95%CI: 1.0-2.4), paternal prescriptive drug use (OR=2.6; 95%CI: 1.1-6.6), and paternal exposure to pesticides (OR=2.1; 95%CI: 0.6-7.1) during the 3 months immediately prior to conception or in the first trimester of pregnancy also appeared to increase the risk of hypospadias. The associations found in this study support the hypothesis that genetic predisposition, placental insufficiency, and substances that interfere with natural hormones play a role in the etiology of hypospadias.

Child↗