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PubMed1997

Mammography screening and the increase in breast cancer incidence in Hawaii.

This ecological study investigated the association between mammography utilization and breast cancer incidence in Hawaii with the hypothesis that geographic areas with high mammography use have higher breast cancer incidence than geographic areas with low mammography use. Insurance claims for mammograms received during 1992 and 1993 were combined with breast cancer incidence data from the Hawaii Tumor Registry and data from the 1990 Census ZIP File. The claims data were obtained from four private and three public health plans and covered approximately 85% of women 40 years of age and older. Age-specific breast cancer incidence rates for the 79 ZIP code areas were regressed on mammography rates and selected aggregate demographic variables using multiple linear regression. An estimated 42% of women 40 years of age and older had received at least 1 mammogram during 1992 and 1993, with the highest rate (45%) in women ages 50-64 years old. Overall, 23% of the variation in age-specific breast cancer incidence could be predicted by mammography utilization, 23% by increasing age, and 4% by higher education. The relationship between mammography use and breast cancer incidence was strongest for women 50-64 years old and for localized disease. The magnitude of the association between breast cancer incidence and mammography utilization was comparable to the increase in breast cancer rates observed in Hawaii during the mid-1980s, supporting the hypothesis that the sharp increase in breast cancer incidence was attributable to screening and early detection. However, the long-term 1% increase in breast cancer incidence requires alternate explanations.

Adult↗

PubMed1997

[Actigraphy: methodological limits for evaluation of sleep stages and sleep structure of healthy probands].

UNLABELLED: Purpose of the investigation was to evaluate the differences of movement density during the sleep stages and waking. 22 diurnally active, healthy, male volunteers of mean age 30.7 (+/-Standard deviation +/- 3.3) years and a Body-Mass-Index 23.6 +/- 3.3 kg/m2 participated in the study. All subjects were recorded in the sleep lab via cardiorespiratory polysomnography and wrist actigraphy (Ambulatory Monitoring, Ardsley, USA) worn on the non-dominant hand, for two consecutive nights. The activity data, consisting of the number of zero crossings (NZC) were recorded in 1-minute periods. Sleep stages were scored visually according to standard criteria. EEG- and actigraphy data were converted to the same data format (European Feature Files). Attaching the actimetry data to the sleep stages was calculated mean NZC for every sleep stage and Wake. In spite of high differences in total individual NZC we observed that most NZC occurred during Wake. NREM 1 movement density was significantly higher in 19 recordings (86%) than in any other sleep stage. In 18 cases (82%) lowest movement density was found in NREM 3/4 with significant difference to all other sleep stages. Within 50% of the recordings were found decreasing activity in the following sequence of stages: Wake > NREM 1 > REM > NREM 2 > NREM 3/4 However, in all other cases there was a varying pattern of activity. CONCLUSION: Although there is some correlation between motor activity and sleep stages, the predictive value of actimetry data analysis in the assessment of sleep structure appeared to be limited mainly by individual movement density, especially during REM and NREM 2.

Adult↗

PubMed1998

[Perinatal mortality at the Medical Care Units of the IMSS (Mexico Social Security Institute), National Medical Center of Torreón].

To describe the situation of perinatal mortality during 1994 year in General Hospitals with Family Medicine number 16 and 18 of IMSS (Social Security Mexican Institut) National Medical Center in Torreón Coah. It was realized a retrospective study, were included 199 files of perinatal deaths occurred from January 1st to December 31 of 1994. The variables obtained were number of death for step, period, age, sex, weight and the cause of the cause of the death. Were eliminated the files without data of interest. For the analysis our utilized descriptive statistics. The rate of perinatal mortality was 20.17 per 1000 live birth, fetal death rate 9.58 by 1000 and the rate of neonatal death 12.97 per 1,000 live birth, fetal death rate 8.68 and neonatal death rate 12.30. The majority were in the perinatal period one with a rate of 16.71 by 1,000 live birth. Were most common in a male sex (53%) in pregnancies from 28 to 32 weeks (33.91%) and in babies with less of 1000 gr of weight (33.86%). The causes more frequents of deaths were the respiratory difficult syndrome (41.77%), the anomalies (19.62%) and hypoxia (9.49%). The perinatal mortality in our study was similar that in the rest of the country and is acorde with the literature. The perinatal mortality were in the perinatal period one. Is important to conduce a prospective studies.

Analysis of Variance↗

PubMed1998

Self-reported chemical sensitivity and wartime chemical exposures in Gulf War veterans with and without decreased global health ratings.

This cross-sectional telephone survey study assessed prevalence rates of current chemical sensitivity, frequency of chemical odor intolerance, and self-reported Persian Gulf chemical exposures among 41 randomly sampled Department of Veterans Affairs outpatients who were Persian Gulf War (PGW) and PGW-era veterans. The participants were drawn from an initial random list of 100 veterans, of whom 28 PGW and 20 era veterans had correct telephone data on file. Of those contacted, 86% of PGW veterans (24/28) and 85% of era veterans (17/20) agreed to participate. Significantly more PGW veterans with poorer global health after military service reported considering themselves now "especially sensitive to certain chemicals" (86%, 12/14) than did the PGW veterans or era veterans in stable health (both comparison groups 30%, 3/10). Among PGW veterans, the subset with worse health associated with marked increases in chemical odor intolerance since their military service had a significantly higher odds ratio for exposure to multiple chemicals, notably wartime pesticides and insect repellent, than did comparison groups. The high rate of chemical sensitivity of PGW veterans with deteriorated health is almost three times that in PGW-era veterans and in elderly primary care outpatient veterans at the same Department of Veterans Affairs medical center and in community-based civilian samples (i.e., 30%). These preliminary findings suggest the need for further study of chemical sensitivity, including tests for acquired increases in neural sensitizability to multiple low-level chemicals, in ill PGW veterans.

Adult↗

PubMed1990

Information system for biomedical equipment management in a wide-area environment.

An information system used in managing the inventory of equipment at the local health units (LHUs) of the Emilia Romagna region is presented. The system aims at efficient management of information on medical equipment and at supporting regional administrators in financial planning. The system uses 'classification files' and 'working files'. The classification files can be either defined at national (classification of producers, models and equipment types) or local (classification of suppliers and hospital departments) level. The working files are used to store all information necessary for the inventory of equipment in the local health unit (equipment inventory file) and results of automatic annual economic computations (residual values and amortisation quota file). Starting from data stored in the above-mentioned files the system can perform several procedures, such as control on data entry, economic computations and report printings. The main aspects of these operations are described in detail. Finally, some information on biomedical equipment of one of the largest local health units of the Emilia Romagna region, obtained from elaboration of system data, is shown and discussed.

Financial Management, Hospital↗

PubMed1979

Development of a multifunctional drug file for hospital pharmacy computer applications.

The development of a multifunctional master drug file (MDF) which satisfies initial pharmacy data base requirements and has the capability to support increasingly sophisticated computer applications is described. The computerized purchasing, inventory, drug use review and formulary systems in a 1,100-bed teaching hospital were evaluated to determine which existing data fields should be included in the MDF, Functional requirements for the MDF and 27 data fields, each with its own particular specifications for programming, were identified. A method of data input was designed to create and maintain the file using keypunched Hollerith cards. Data input forms were designed to serve as coding documents for drug file data. Verification of all data in the file can be performed by running a program which lists the contents of each drug recorded. Based on 1975 salary rates, the total cost of the MDF development was $4,010; total time required was 640 hours. Approximately one hour per week is needed to keep the file contents up to date. File design specifications and contents are discussed, with special emphasis on the functional aspects of the MDF. The MDF successfully fulfilled the initaial pharmacy computer system requirements and has the potential to accommodate increasingly sophisticated applications.

Computers↗

PubMed2006

A high-speed scintillation-based electronic portal imaging device to quantitatively characterize IMRT delivery.

We have developed an electronic portal imaging device (EPID) employing a fast scintillator and a high-speed camera. The device is designed to accurately and independently characterize the fluence delivered by a linear accelerator during intensity modulated radiation therapy (IMRT) with either step-and-shoot or dynamic multileaf collimator (MLC) delivery. Our aim is to accurately obtain the beam shape and fluence of all segments delivered during IMRT, in order to study the nature of discrepancies between the plan and the delivered doses. A commercial high-speed camera was combined with a terbium-doped gadolinium-oxy-sulfide (Gd2O2S:Tb) scintillator to form an EPID for the unaliased capture of two-dimensional fluence distributions of each beam in an IMRT delivery. The high speed EPID was synchronized to the accelerator pulse-forming network and gated to capture every possible pulse emitted from the accelerator, with an approximate frame rate of 360 frames-per-second (fps). A 62-segment beam from a head-and-neck IMRT treatment plan requiring 68 s to deliver was recorded with our high speed EPID producing approximately 6 Gbytes of imaging data. The EPID data were compared with the MLC instruction files and the MLC controller log files. The frames were binned to provide a frame rate of 72 fps with a signal-to-noise ratio that was sufficient to resolve leaf positions and segment fluence. The fractional fluence from the log files and EPID data agreed well. An ambiguity in the motion of the MLC during beam on was resolved. The log files reported leaf motions at the end of 33 of the 42 segments, while the EPID observed leaf motions in only 7 of the 42 segments. The static IMRT segment shapes observed by the high speed EPID were in good agreement with the shapes reported in the log files. The leaf motions observed during beam-on for step-and-shoot delivery were not temporally resolved by the log files.

Computer Systems↗

PubMed1978

[Groupamatic in the general organization of collecting and utilization of blood at C.N.T.S].

The automatization of immunohematological tests on Groupamatic equipments and its integration in a data management system of blood units and donor files has been brought about progressively, takinginto account the initiator status of the C.N.T.S. and its priviliged relationship with the manufacturer. A set of different problems was thus successively studied, the solutions of which lead to the development of new techniques, concerning the machine itself and its surroundings: --blood collection: -taking of blood sample on vacutainers containing anti-coagulant, without dilution, at a constant level and clot free; --identification: -connection between blood sample and blood unit by the creation of an identification number on twin labels (2 part card); -donor blood donation connection; --utilization of Groupamatic results: -edition of result listings; -study and use of an automated labelling of blood units; --setting up and daily updating of donor files: -blood collection data management; -creation of a badge--link between blood donation, files and donors. These constant improvements of both system and techniques have helped to put us within reach of the goal set as early as 1963 with Dr. C. Matte, that is to say the establishment of a fully automated system avoiding any intervention other than blood collection. Thus, due to the suppression of retranscription, this system increases the safety and enables the use of previously known donor characteristics.

Autoanalysis↗

PubMed2006

Use of medical insurance claims data for occupational health research.

OBJECTIVE: The objective of this study was to demonstrate that health claims data, widely available due to the unique nature of the U.S. healthcare system, can be linked to other relevant databases such as personnel files and exposure data maintained by large employers. These data offer great potential for occupational health research. METHODS: In this article, we describe the process for linking claims data to industrial hygiene exposure data and personnel files of a single large employer to conduct epidemiologic research. RESULTS: Our results demonstrate the ability to replicate previously published findings using commonly maintained data sets and illustrate methodological issues that may arise as newer hypotheses are tested in this way. CONCLUSIONS: Health claims files offer potential for epidemiologic research in the United States, although the full extent and guidelines for successful application await further clarification through empiric research.

Adult↗

PubMedDate not supplied

Retrospective data quality audits of the Harvard Six Cities and American Cancer Society studies.

The Harvard Six Cities (6-Cities) and American Cancer Society (ACS) studies are longitudinal cohort mortality studies of large populations that provided important information about the human health effects associated with long-term exposure to fine particulate air pollution. Possible changes to federal regulation of particulates prompted a review of data collection methods, analysis, and reported results from these two studies. This article describes the methodology used to conduct quality assurance audits of both studies and summarizes the audit findings. Statistically based, randomly selected samples of 250 health questionnaires and 250 death certificates from each study were audited against data from analysis files. In cases where study-specific data could not be located, validation was performed using information and data from other sources. Some errors were found in programming and data transformation in both studies, but none affected the results of the original investigations. Both audits confirmed that the published studies are an accurate representation of the collected data. The audits also underscored the importance of adequate attention to documentation and record-keeping practices during the conduct of all studies and proper archiving at their conclusion.

Air Pollution↗

PubMed2001

[Survival of tetraplegic spinal cord injured persons after the first admission of a rehabilitation center and prognosis factors: a multicenter study of 697 subjects in French centers].

BACKGROUND: We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center. METHODS: This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival. RESULTS: Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4. CONCLUSION: Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.

Adult↗

PubMed2004

Managing data for a multicountry longitudinal study: experience from the WHO Multicentre Growth Reference Study.

The World Health Organization (WHO) Multicentre Growth Reference (MGRS) data management protocol was designed to create and manage a large data bank of information collected from multiple sites over a period of several years. Data collection and processing instruments were prepared centrally and used in a standardized fashion across sites. The data management system contained internal validation features for timely detection of data errors, and its standard operating procedures stipulated a method of master file updating and correction that maintained a clear trail for data auditing purposes. Each site was responsible for collecting, entering, verifying, and validating data, and for creating site-level master files. Data from the sites were sent to the MGRS Coordinating Centre every month for master file consolidation and more extensive quality control checking. All errors identified at the Coordinating Centre were communicated to the site for correction at source. The protocol imposed transparency on the sites' data management activities but also ensured access to technical help with operation and maintenance of the system. Through the rigorous implementation of what has been a highly demanding protocol, the MGRS has accumulated a large body of very high-quality data.

Child Development↗

PubMedDate not supplied

Computer storage of toxicology methods and postmortem drug determinations.

Two data bases have been developed by toxicologists from the Department of Scientific and Industrial Research in New Zealand. The data bases are designed to store and retrieve postmortem drug and poison levels (TOXFILE) and methods used in drug and poison determinations (TOXMETH). TOXFILE contains a list of all the analytical results determined in toxicological cases received by the three laboratories. This method of storing the data has been found superior to the previously used card systems. The file also contains a reference to the analytical method which is very important for the interpretation of the results. TOXMETH contains a list of the analytical methods which have been developed and are in use in one or more of the three Chemistry Division toxicology laboratories. Methods can be added, modified and superseded as approaches change. A Chemistry Division Report (Pannell, L.K. et al., Chemistry Division Report No. CD: 2195, 1983) has been published containing all the programs and instructions. Copies of this are available from the authors on request. Computer magnetic tapes of the programs, the report and the data are also available. The names of the deceased on the TOXFILE data file are encrypted to provide increased security of the information. The TOXFILE data file which will be supplied on magnetic tape to overseas laboratories will have the name file on all records changed to 'CD' to provide complete confidentiality.

Autopsy↗

PubMed1982

Changing an automated drug inventory control system to a data base design.

A pharmacy department's change from indexed sequential access files to a data base management system (DBMS) for purposes of automated inventory control is described. The DBMS has three main functional areas: (1) inventory ordering and accountability, (2) charging of interdepartmental and intradepartmental orders, and (3) data manipulation with report design for management control. There are seven files directly related to the inventory ordering and accountability area. Each record can be accessed directly or through another file. Information on the quantity of a drug on hand, drug(s) supplied by a specific vendor, status of a purchase order, or calculation of an estimated order quantity can be retrieved quickly. In the drug master file, two records contain a reorder point and safety-stock level that are determined by searching the entries in the order history file and vendor master file. The intradepartmental and interdepartmental orders section contains five files assigned to record and store information on drug distribution. All items removed from the stockroom and distributed are recorded, and reports can be generated for itemized bills, total cost by area, and as formatted files for the accounts payable department. The design, development, and implementation of the DBMS took approximately a year using a part-time pharmacist and minimal outside help, while the previous system required constant expensive help of a programmer/analyst. The DBMS has given the pharmacy department a flexible inventory management system with increased drug control, decreased operating expenses, increased use of department personnel, and the ability to develop and enhance other systems.

Computers↗

PubMedDate not supplied

Reporting, filing, and retrieval of coronary angiographic findings: a new personal computer-based system.

A software system for semiautomatic reporting and automatic filing of coronary angiographies has been developed and is suitable for an IBM Personal Computer (PC) with graphic tablet and printer. Coronary angiographic findings referring to the native anatomy, pathology, and post-surgical status can be easily recorded. The data is automatically coded and filed according to category of information. This system can analyze previously filed data and perform searches under one or more angiographic findings. This allows for a comparison of different series of patients.

Algorithms↗

PubMed1982

[Organization of a patient's file of a radio-chemo-therapy department by means of a mini-computer (author's transl)].

The clinical research in the oncological field makes it necessary to have in the shortest possible time information as to the statistical elements of the various neoplasias according to the adopted treatment schemes. In this report we are going to describe the realization of a computerized file with the patient's data of our radio-chemo-therapy department. From the clinical report of each patient, according to the physician's judgement, the more important medical and anagraphical data have been taken out to be then memorized in the computer. The analysis of the data introduced allows to obtain an inventory of patients in alphabetical order, according to the type of neoplasia and to the type of the treatment. The system is quite easy to be used and the interaction with the user is dialogue oriented. In this way both the inserting and the research stage of the filing data as well as the printing of the lists can be effected even by people not particularly trained in the computer use.

Computers↗

PubMed1994

Integrating a digital dictation system with a network data base for creating and managing radiologic teaching files.

RATIONALE AND OBJECTIVES: A method for facilitating the creation and management of radiologic teaching files is described. METHODS: A digital dictation system was integrated with a personal computer data base. The data base is maintained with user-friendly, graphically oriented software. Radiologists can dictate any examination for the teaching file from any dictation station in the department with minimal interruption of their clinical activities. The data base resides on a file server, thus providing department-wide access for radiologists and students. RESULTS: Attending radiologists and residents have responded favorably to the system. Maintenance and retrieval of teaching files are facilitated by using a computer for otherwise tedious aspects of information management. Data are stored in a well-organized manner, thus increasing the value of the teaching file while reducing redundant data entry. CONCLUSION: Computer technology can facilitate the maintenance of radiologic teaching files. Radiology departments that have a convenient, department-wide method for entering cases--such as a digital dictation system and existing computer network--are ideal for the technique that we describe.

Humans↗

PubMed1998

Data base management in interventional electrophysiology--the relational advantage.

UNLABELLED: A relational database was designed to facilitate patient management and storage of complex electrophysiologic data of patients undergoing radiofrequency catheter ablation. The database has to deal with multiple data entries per patient record like radiofrequency current applications and catheters. BACKGROUND: Due to the complexity of catheter mapping and ablation therapy, the investigators have to handle various data types. Contradictory to a flat-file database, a relational structured database is not limited to a "single record structure". IMPLEMENTATION: The designed database is built on the relational database programming environment 4th Dimension (ACI). It is implemented on an Apple Macintosh computer system. The relational structure consists of 13 data files and enables an unlimited data entry of multiple items per data field: In 1288 patients 10308 radiofrequency current applications were applied for ablation therapy and 4798 diagnostic or therapeutic catheters were used.

Arrhythmias, Cardiac↗