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At least 1,693 records · Page 94Linked to original sources
PubMed2006

[Dermatitis artefacta: retrospective study in 31 patients].

BACKGROUND: The outcome for patients with dermatitis artefacta is not well known. The primary objective of this single-centre retrospective study was to describe the initial clinical aspects and the prognosis of the disease. The secondary objective was to describe the somatic and psychological management and long-term treatment of these patients. PATIENTS AND METHODS: Records of patients with dermatitis artefacta followed in the dermatology department over the 15 last years were reviewed independently by 2 dermatologists. Diagnostic criteria consisted of evocative clinical pictures and the exclusion of other forms of dermatosis. Data collection included: file analysis, photographs, review questionnaires sent to general practitioner or completed during a phone call to patients (follow-up data). RESULTS: Thirty-one patient files were selected: 23 women and 8 men, mean age 31 years (SD = 14.8). Clinical aspects included: erythema (50%), ulceration (37%), crust (23%) and blisters (17%). The main sites were the face (67%) and arms (43%). Topical treatment was prescribed in all cases and systemic treatment was prescribed in 23% of cases. Psychological support was offered to 65% of the patients and was accepted by 50%. A follow-up study was performed for 17 patients and showed serious complications in 4 cases consisting of psychosis (n=2) and/or severe self-mutilation (n=3) occurring over several years following diagnosis (5 years for one patient and 12 years for 2 patients). DISCUSSION: The results confirm the usual and characteristics of dermatitis artefacta such as predominance in young female patients, with lesions affecting visible areas (face, upper legs). In contrastwith published studies, no cases of attempted suicide were observed in our series, although severe dermatitis artefacta was evidenced in only a minority of patients.

Adult↗
PubMed1988

A computer-assisted diary (CAD) for ambulatory blood pressure monitoring.

Methods for logging activities during ambulatory blood pressure monitoring are time consuming and poorly standardized. To overcome these problems we have developed a computer-assisted diary (CAD). The subject marks boxes on a computer-readable card to indicate the time, location, body position, activity, and mood associated with each blood pressure reading. Software implemented on a personal computer downloads the diary information from a card reader, checks its quality, scores the data, extracts quantitative critical features, and inserts the information into computer files ready for data analysis and clinical report writing. The diary system was tested on 24-hour blood pressure scans of 32 normotensive working adults. The results indicated that the automated diary system was accepted well and used accurately by the subjects. Activities and moods coded by the CAD system were systematically related to the level of systolic blood pressure. The method produced results that are similar to those of traditional diaries, with major time and cost savings resulting from computer automation. We have concluded that the computer-assisted diary is an effective way to monitor behavioral states during ambulatory blood pressure monitoring which merits further trial applications.

Activities of Daily Living↗
PubMed2001

Geriatric services offered by hospitals: predicting services by internal and external community characteristics.

This article explores the role of hospitals in providing geriatric services and identifies associated community and hospital characteristics. The sample is 4571 community hospitals responding to the 1995 American Hospital Association (AHA) Annual Survey. Most hospitals offer some geriatric services; the mean is 3.3. The dependent variable is an index of 13 geriatric services created from the AHA data. Independent variables are taken from the AHA survey, Area Resource File, and census data. Regression analysis explains fifteen percent of the variance. Hospital characteristics predicting provision of geriatric services are non-profit tax status, hospital bed size and system membership. Community characteristics predicting provision of geriatric services included higher population density, high percentage of county aged, and county nursing facility beds. Hospital characteristics yielded slightly higher predictive ability than did community characteristics. The findings suggest policies to increase hospital leadership in providing access to senior services require a multi-dimensional approach.

Aged↗
PubMed2000

EthoLog 2.2: a tool for the transcription and timing of behavior observation sessions.

EthoLog is a tool that aids in the transcription and timing of behavior observation sessions--experimental or naturalistic, from video/audio tapes or registering real time. It was created with Visual Basic and runs on Windows (3.x/9x). The user types the key codes for the predefined behavioral categories, and EthoLog registers their sequence and timing and saves the resulting data in ASCII output files. A sequential analysis matrix can be generated from the sequential data. The output files may be edited, converted to plain text files for printing, or exported to a spreadsheet program, such as MS Excel, for further analyses.

Behavior↗
PubMedDate not supplied

Limitation of medical research in German law.

In Germany, pharmaceutical trials and the testing of medical devices is regulated by statute. Any other kind of medical experimentation is handled according to the Declaration of Helsinki. Medical experimentation has to be reviewed by an ethics committee before the start and there has to be an elaborate research protocol, which provides for the protection of the experimental subject. In case of an accident, there is compulsory accident insurance as far as pharmaceutical trials and the testing of medical devices are concerned. The third party accident insurance just covers material loss, there is no provision paying and suffering. The sum paid by the insurance company is set off against damages for negligence. There is no strict liability for medical experimentation, but the German courts are expected to set very high standards for medical care in experimentation. The data protection and medical confidentiality have been lessened because of the European law that requires the experimental subject to give his consent to the inspection of the data or the file and if he takes part in the experimentation, that his data and some of his cells might be with the pharmaceutical company forever. In general, the German law seems to be adequate to the protection of experimental subjects.

Biomedical Research↗
PubMed1988

Predicting rehabilitation outcomes from clinical and statistical data: a probability model.

This research was focused on the feasibility of a Markov Chain probability model for predicting rehabilitation outcome. A combination of clinical ratings from counselors and statistical data from client files was used to predict 'successful' and 'unsuccessful' outcomes. Predictions were made at three separate time periods: Time 1, during the first week after initial interview; Time 2, during the fourth week after initial interview; and Time 3, during the thirteenth week after initial interview. The final outcome was determined at the end of six months. The research sample consisted of seventy-one clients from two private rehabilitation agencies, all of whom suffered from work-related injuries or illnesses. The results of this research indicate that a Markov Chain probability model is quite feasible for predicting rehabilitation outcomes. In addition, it was observed that the predictions generally followed a progression over time toward stronger and more accurate predictions for both 'success' and 'failure'. With only one exception, occurring at Time 1, the clinical ratings from the counselors were shown to be stronger predictors than the statistical data from case files. This finding is inconsistent with previous studies. It is suggested that a model such as this can serve to alert counselors to the possible need for different or more innovative strategies for service to clients who show a poor probability for success.

Accidents, Occupational↗
PubMed2005

Helping social workers address the educational needs of foster children.

OBJECTIVE: The main aim was to evaluate the effectiveness of the Education Initiative, an intervention program in one of the largest urban counties in the US seeking to increase the responsiveness of social workers to the educational needs of foster children. METHOD: A pre-post test control group design was used. Data from case files and social workers were examined at the start of the project and 18 months later to determine changes in social workers' (a) knowledge and practices regarding school programs and services and (b) maintenance of educational records for children on their caseloads. RESULTS: Data were analyzed from approximately 300 case files and over 200 questionnaires completed by social workers. Findings indicated that social workers who received training and had access to an education liaison (1) increased their knowledge about the school system and (2) were more likely to gather current educational data and comment on schooling needs in the case files. On questionnaires measuring knowledge and practices, supervisory social workers showed no gains while case workers increased their levels of knowledge and involvement. CONCLUSIONS: Evaluative data from both sources support the effectiveness of this collaborative model between the school and child welfare agency for addressing the educational needs of foster youth. Social workers in the pilot offices knew more and focused more on the school experience of youth on their caseloads than workers in the control offices. They reported more educational information in the case files and solicited current progress reports from the schools. Discrepancies between worker and school reported performance data raise questions as to whether social workers by themselves are the most effective advocates for foster children.

Adolescent↗
PubMed1998

Does hospital procedure-specific volume affect treatment costs? A national study of knee replacement surgery.

OBJECTIVE: The long-run cost savings potential of private sector reform efforts, such as selective contracts with providers, depends in part on the relationship between procedure-specific volume and average hospital resources that are consumed in treating patients associated with that specific procedure. Study examines a model that estimates the relationship between hospital procedure-specific volume and average hospital treatment costs, using an elective surgical procedure as an example. DATA SOURCES: Medicare Provider Analysis and Review (MedPAR) files for 1989 for hospitalizations in which a Medicare beneficiary received a knee replacement (KR) surgery during 1989. Hospital information was obtained from the American Hospital Association's 1989 Annual Survey. All patient-level data were aggregated to the hospital level to create a data file, with the hospital as the unit of observation. STUDY DESIGN: This study used administrative claims data and regression analysis to estimate the effect of hospital procedure-specific volume on average hospital treatment costs of patients receiving KR surgery. We also examined the stability of the volume-cost relationship across hospitals of different sizes. PRINCIPAL FINDING: The average treatment costs associated with KR surgery are inversely related to a hospital's KR volume in the regression equation estimated using all hospitals performing KR surgery. The inverse relationship between cost and volume is found to be robust for different-size hospitals. CONCLUSIONS: The potential cost savings associated with performing KR surgery at incrementally higher hospital volume level can amount to as much as 10 percent of the hospital's average treatment cost. However, the incremental cost savings associated with increased patient volume depends on the hospital's current volume level and its size.

Aged↗
PubMed2007

An integrated approach to a teaching file linked to PACS.

To meet the educational needs of a medical imaging department with a strong teaching commitment, a teaching file that uses digital data supplied by the institutional picture archiving and communications system (PACS) was required. This teaching file had to be easily used by the end users, have a simple submission process, be able to support multiple users, be searchable on all data fields, and implementing the teaching file must not incur any additional software or hardware costs. The teaching file developed to address this problem takes advantage of the database structure and capabilities of several components included in the commercial PACS installed at the hospital. MS Access is used to seamlessly integrate with the digital imaging and communication in medicine (DICOM) database of a normal work station that is part of the PACS. This integration allows relevant patient and study demographics to be copied from images of interest and then to be stored in a separate database as the back-end of the digital teaching file. When images for a particular teaching file case need to be reviewed, they are automatically retrieved and displayed from the main PACS database using an open application programming interface (API) connection defined on the PACS web server. Utilizing this open API connection means the teaching file contains only the relevant demographic information of each teaching file case; no image data is stored locally. The open API connection allows access to imaging data usually not encountered in a teaching file, allowing more comprehensive imaging case files to be developed by the radiologist. Other advantages of this teaching file design are that it does not duplicate image data, it is small allowing simple ongoing backup, and it can be opened with multiple users accessing the database without compromising data access or integrity.

Computer-Assisted Instruction↗
PubMed1982

C2: a data base management system developed for the Coronary Artery Surgery Study (CASS) and other clinical studies.

For the Coronary Artery Surgery Study (CASS), large variable amounts of data on different form-types are collected on many different patients. In this paper, we describe C2, a "state-of-the-art" command-oriented data base system developed in response to the needs of maintaining a large complex data base and performing subsequent analyses on a large number of studies. C2 provides a friendly, interactive interface with the researcher as well as a powerful method for data extraction, data transformation, and the merging of files from the CASS data base.

Clinical Trials as Topic↗
PubMed2003

Development of a centralized inland marine hazardous materials response database.

The state of the practice for obtaining chemical reference at a typical hazardous materials transportation accident scene is to consult multiple printed references. This often leads to confusion. This paper describes the design and development of a centralized response database. This is accomplished by identifying the most commonly used emergency response databases for all modes of transportation, developing relationships between the data, and building intuitive interfaces that allow for rapid information retrieval. The tool is subsequently applied to a previous accident to demonstrate the value-added from its availability in a response scenario. By combining all datasets in one application, data redundancy, errors and lags between updates of the data sets can be reduced. The linkages between the database and supporting files enables the data to be easily updated. While the database is designed to aid response to marine transportation accidents, the tool could also be applied to other modes of transportation. Moreover, facility and vessel operators could benefit from having a comprehensive chemical source accessible in case of release or human contact with the material. Finally, the inclusion of commodity flow information enables decision makers to prepare for high risk commodities.

Accidents, Occupational↗
PubMed1992

Survey of clinical pharmacokinetic software for microcomputers.

Twelve distributors of pharmacokinetic software programs for microcomputers were surveyed to determine scope of drug coverage; the pharmacokinetics models, methods, and equations used; hardware requirements including use of math coprocessor, random access memory (RAM) required, storage space, printer support and mouse use; software features including availability of windows, pull-down menus, context sensitive help, graphical representation of data, ability to export data including to ASCII file and ability to store patient data; availability of support including toll-free telephone numbers, 24-hour support and clinical consultations; costs; and frequency of updates.

Clinical Pharmacy Information Systems↗
PubMed1991

A methodology for building an AIDS research file using Medicaid claims and administrative data bases.

There is a current and continuing need for health services research on the epidemiology of AIDS and its impact on health care systems. However, large data bases designed for other purposes, such as hospital discharge abstract systems and medical claims systems, are the primary source of data for AIDS research. Thus, methodologies must be developed that enable researchers to investigate AIDS using data bases designed for other purposes. In this report, we describe a methodology for utilizing Medicaid Management Information Systems (MMIS) data to conduct health services research on AIDS. We developed an ICD-9-CM diagnosis-based algorithm that accurately identified the majority of AIDS cases, both before and after AIDS-specific ICD-9-CM codes became available in October 1986. Using diagnostic categories that we had developed previously to identify AIDS cases among disabled young men in California on Medicaid, we expanded the methodology to include children, men, and women of all ages in California and New York. The algorithm worked best with young disabled males, older males, and females between 18 and 50 years of age. The algorithm worked least well with nondisabled males, females over age 50 years, and children. We also developed methodologies for defining Medicaid AIDS onset, risk group, and date of death. Our research resulted in the identification of a study population representing the majority of Medicaid AIDS cases between 1983 and 1986 in California and New York. The AIDS study population data base was used in further research on eligibility patterns, the epidemiology of the AIDS epidemic, lifetime Medicaid utilization and expenditures, and the development of a survival-based severity index for Medicaid recipients with AIDS.

Acquired Immunodeficiency Syndrome↗