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At least 1,747 records · Page 97Linked to original sources
PubMed1997

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

OBJECTIVE: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. SETTING: Inner city group practice with a socioeconomically diverse population. SUBJECTS: 382 male and female subjects of all ages, with a total of 1296 person years of observation. MAIN OUTCOME MEASURES: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. RESULTS: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. CONCLUSIONS: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

Adolescent↗
PubMed1999

Secondary data bases and their use in outcomes research: a review of the area resource file and the Healthcare Cost and Utilization Project.

Secondary data sources are being used more frequently than ever in outcomes research. The speed and relative low cost of these data bases makes them ideal for analyzing outcomes. Today's researcher has numerous secondary data bases available for use. Few publications exist to help researchers locate the ideal data set for their needs. Herein, two national secondary data bases are reviewed: the Area Resource File (ARF) and the Healthcare Cost and Utilization Project (HCUP). These two data sets represent the two types of secondary data: aggregate and individual. ARF represents an aggregate data set and HCUP represents an individual data set. The advantages of each type of secondary data will also be reviewed.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Record linkage strategies. Part I: Estimating information and evaluating approaches.

Record linkage techniques can help identify the same patient for matching diverse files (hospital discharge abstracts, insurance claims, registries, Vital Statistics data) which contain similar identifiers. Prior knowledge of whether a linkage is feasible is important to prevent wasted effort (additional data collection or data manipulation), which decreases the cost-effectiveness of the linkage. Using examples generated by linking the Manitoba Health Services Commission data with Vital Statistic files, a method of estimating the information in each data set is presented first. Further, the feasibility of several different record linkage strategies is described and tested, given varying amounts of information. At the margin, relatively small amounts of information (having just one more variable to match with) can make a great difference. Probabilistic linkage's great advantage was found in those situations where only a moderate amount of extra information was available. By using the above techniques when working with one or both files in a proposed record linkage project, a much more informed judgement can now be made as to whether a linkage will or will not work. In facilitating record linkage, flexibility of both software and the strategy for matching is very important.

Data Collection↗
PubMed1996

[Model for a computer-assisted quality assurance system in burn intensive care].

The prerequisites for an integrated quality management system for hospitals were developed as a result of considerations regarding the necessity of an appropriate quality-assurance system for the intensive care sector. The basis for a dynamic quality-assurance system on the documentational level is a comprehensive data base containing patient files unlimited in terms of time and data technology. The necessary hardware and software structure will be provided by consistent application of a client-server architecture. Permanent surveillance of existing quality objectives within the scope of an economic close-loop system requires a system with flexible query mechanisms. Informational data access from all hierarchical level within the hospital organization is facilitated by the data warehouse concept, a data base system with subject-oriented, integrated, time-variable, and persistent data.

Burn Units↗
PubMed2006

Prevalence and clinical aspects of Behcet's disease in the north of Israel.

Behcet's disease (BD) has a higher prevalence in countries along the ancient silk route, but the actual prevalence in Israel is unknown. We evaluated the occurrence and clinical expression of BD in the northern region of Israel: in the whole population and by ethnic groups. The sample included all adult patients with BD (International Study Group criteria) treated at three medical centers in northern Israel. Patient data were collected by file review and physician survey. Relevant demographic data for the population served by the medical centers were obtained from the official Israeli authorities. A total of 112 patients were identified. The overall prevalence of BD was 15.2/100,000 and was similar in men and women. The prevalence rates among the Jewish, Arab, and Druze populations were 8.6, 26.2, and 146.4 per 100,000, respectively. Age at disease onset was similar in all ethnic groups and significantly lower in males (28.6+/-9.7 vs 32.9+/-11.3, p=0.03). There were no differences in disease manifestations by sex or ethnicity. All Druze patients were HLA-B5 positive, compared to 80.8% of the Arab patients and 72.0% of the Jewish patients. Recurrent oral ulcers in family members were more common in Arab patients (p=0.004). The BD severity index was significantly lower in Druze patients (p=0.05), mainly in males (p=0.03). This study confirms the high prevalence of BD in Israel and the variability in disease rates and expression by ethnic origin. Our findings, particularly regarding the Druze population, call for further field surveys and genetic studies.

Adult↗
PubMed1999

Myocardial sestamibi uptake in healthy subjects is related to age, gender and habitus.

The object of this study was to evaluate the effect of gender, age and anthropometric data on regional isotope uptake in myocardial perfusion scintigraphy using 99mTc-MIBI-SPECT (myocardial sestamibi single-photon emission technique). Seventy-one healthy, non-smoking subjects, 42 men and 29 women between 40 and 80 years of age, with less than 5% likelihood of having coronary artery disease were studied. All subjects underwent a maximal exercise and rest MIBI-SPECT using a 2-day protocol and a 180 degrees anterior circular rotation. No correction for scatter or attenuation was made. Normalized regional activity was different in men and women in the anterior and inferior regions, with higher values anteriorly in men and inferiorly in women. Regional activity also differed with age in both women and men with higher relative activity in the anterior regions in the oldest age groups. Higher activities were seen in the basal parts of the left ventricle at rest compared with stress in both men and women. Regional isotope uptake was significantly affected by habitus expressed as body mass index (BMI) and thoracic circumference. Different protocols for stress and rest seem to be needed for men and women in different age groups, and for stress and rest when performing semiquantitative MIBI-SPECT and comparing data with a normal file of healthy subjects. Furthermore, such anthropometric data as BMI and/or thoracic circumference should be considered in order to minimize the risk for false-positive or false-negative scintigraphic results.

Adult↗
PubMed1988

Design of clinical database management systems and associated software to facilitate medical statistical research.

Clinical databases are growing rapidly. The clinical database is heavily used for medical research in many settings. This paper discusses design features for medical databases that facilitate their use for research. The database management system should allow complex data structures, have a syntax-facilitating collection of longitudinal data, interface with major statistical software packages, allow an extensive data dictionary, conveniently merge files, facilitate archival documentation, have an associated data entry system that allows complex logical checking, and have coordinated mainframe and microcomputer software.

Biometry↗
PubMed2003

ProteomeWeb: a web-based interface for the display and interrogation of proteomes.

The analysis of proteomes, i.e., the proteins expressed by biological organisms under a given set of conditions at a given time, requires separating complex protein mixtures into discrete protein components, measuring their relative abundances, and identifying the individual protein components. Many types of data are generated during the course of proteome analysis, including graphic images of the protein profiles, flat files containing numeric data, spreadsheets for assimilating numeric data, and relational database tables for integrating data from multiple experiments. As part of a project to describe the proteomes of microbes of interest to the U.S. Department of Energy, a World-Wide Web-based interface has been developed for the display of protein profiles generated by two-dimensional gel electrophoresis. The web interface is capable of obtaining protein identifications on the fly, interrogating the quantitative data in the context of available genome sequence information, and relating the proteome data to existing metabolic pathway databases. Analysis of protein expression profiles is expedited, providing the capability to efficiently determine the gene locations for proteins modulated in abundance in response to different growth conditions and to locate the positions of the proteins within specific metabolic pathways. The proteome of the archaeon Methanococcus jannaschii, a microbe for which the complete genome sequence is available, is used to demonstrate the capabilities of this evolving web interface (http://proteomeweb.anl.gov).

Amino Acid Sequence↗
PubMed2002

Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement.

BACKGROUND: Increasingly, investigators are using administrative databases to answer research questions requiring physician characteristics information. This article provides a roadmap for investigators who use Medicare data to answer such questions, focusing on use of the Surveillance, Epidemiology, and End Results (SEER)-Medicare files. METHODS: Three data sources that can be linked to identify physician characteristics-Medicare claims, the Unique Physician Identification Number (UPIN) Registry, and the American Medical Association (AMA) Masterfile-were examined for data availability, linkage rates, and quality. These databases also were used to explore measurement issues regarding physician specialty and practice volume. RESULTS: Over 98 percent of UPINs identified from the Medicare claims could be linked with both the AMA Masterfile and the UPIN Registry. The AMA Masterfile is the best source of sociodemographic and medical training information; the Medicare claims are the best source of practice ZIP code; and the UPIN Registry is the best source of practice organization data. The operationalization of variables such as physician specialty and practice volume is dependent on the specific research question that is being addressed. CONCLUSION: Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.

American Medical Association↗
PubMed2001

Mountaineering fatalities in Mt Cook National Park.

AIM: To estimate the risk of death associated with mountaineering in the Mt Cook National Park (MCNP), and to describe some characteristics of the fatal events. METHODS: Fatality data, including coroners' files, were obtained from the Mountain Safety Council and the Department of Conservation, Mt Cook field office. Data on occupancy of mountain huts were used to estimate rates. RESULTS: 33 deaths occurred among climbers using the alpine huts studied, over a period in which climbers spent 52 906 nights in the huts. The overall fatality rate was 0.62/1000 hut nights. This is estimated to equate with a fatality rate of 1.87/1000 climbing days. Fatality risk estimates varied more than 50-fold between huts serving the highest risk (6.5/1000 days) and lowest risk (0.3/1000 days) climbing areas within the MCNP. CONCLUSION: The risk of death associated with mountaineering in MCNP varies greatly with the difficulty and seriousness of the climbing undertaken. The risk associated with the more serious climbing in MCNP is very similar to that reported for climbers on expeditions to extreme altitude. Even the lower risk estimates are very high when compared with those for most other recreational activities.

Accidents↗
PubMedDate not supplied

Using the Veterans Health Administration inpatient care database: trends in the use of antireflux surgery.

Context. In the private sector, the use of surgery to treat gastroesophageal reflux disease has increased substantially since the development of minimally invasive laparoscopic techniques. However, trends in the use of antireflux surgery in the Veterans Affairs (VA) health care system have not been explored. Objective. To compare secular trends in the use of antireflux surgery in VA hospitals and the private sector. Data Sources. VA data are from the 1991-1999 medical SAS datasets for inpatient care (commonly known as patient treatment files); private sector data are from the 1991-1997 Nationwide Inpatient Sample and the U.S. census. Calculations. We compared secular trends in the use of antireflux surgery in the VA and private sector with each group's baseline rate in 1991. For the VA, we calculated annual rates of antireflux surgery among active users of the VA health care system by dividing the number of procedures (based on the appropriate procedure codes from the International Classification of Diseases, ninth revision, clinical modification) by the number of veterans who had at least two hospital or clinic visits in a given year. For the private sector, we calculated true population rates by dividing procedure counts by the total U.S. population. Results. From 1991 to 1995, the annual rate of antireflux surgery among active users of VA hospitals increased by 64%, then decreased over the next 4 years to almost baseline rates. In contrast, rates of antireflux surgery in the private sector increased 185% from 1991 to 1995, then appeared to reach a plateau thereafter. Among patients undergoing antireflux surgery, those in the VA were less likely than those in the private sector to undergo laparoscopic surgery (29% vs. 65%, respectively, in 1997). Conclusions. With the development of laparoscopic surgery, rates of antireflux surgery in VA hospitals increased only modestly compared with the private sector and have decreased in recent years. Both patient and provider factors may explain the substantially higher use of this procedure in the private sector.

Age Factors↗
PubMed1978

[Experience in application of electronic data processing in routine medical microbiology (author's transl)].

Experiences in a two years application of electronic data processing in medical routine microbiology are reported. Optical mark reader forms serve as request forms as well as workprotocol. On the left two thirds of these forms (Fig. 1 and 2) the patients data including clinical statements, and the kind of specimen to be investigated (sputum, smear etc.) as well as results not essential for the printout of laboratory reports are filled in. On the right third of the optical mark reader form, in which area the Bell & Howell document reader can read pencil marks, the patients identification number, the tests requested and all results are marked right at the work bench. As shown in the flow diagram (Fig. 3) after completion of the investigation the date on the mark reader forms are read mechanically and the test results are printed (Fig. 5) by means of the computer. In addition, the data processing system, which proved to be very flexible, performs all necessary types of administrative work as filing of laboratory data in a coded form on cards for permanent storage (Fig. 7) statistics and the printout of bills (Fig. 6). The processing of routine microbiology date is achieved by a Siemens DVA 404/3 (64 kbt) connected for magnetic disc device (2993 Mio bytes), and a line printer (60,000 lines per hour) and dialog display monitors, which are used simultaneously for the on line and off line handling of all the data in clinical chemistry-, serology- and hematology-departments of the same institute.

Computers↗
PubMed1989

[Proposal of a standardized graphic system for collecting coronary angiographic data. Processing with a personal computer].

A standardized method for the representation and filing of coronary angiographies is proposed. Semi-automatic reference is guided by a computer algorithm. The final report displays a diagram which shows all the information in graphic and alpha-numeric form. Personalized coronary anatomy is drawn using the Coronary Artery Surgery Study (CASS) guidelines. The algorithm semi-automatically designs coronary segments according to CASS criteria. Five levels of percentage reduction in luminal transverse diameter (25, 50, 75, 90, 100%) can be represented. In addition, plaque morphology (concentric or eccentric, greater or less than 0.5 cm in size) and plaque complications, (calcification, ulceration, thrombosis, aneurysmal dilatation, wall irregularity, and diffuse disease) can be added as additional information. Twenty pathological entities (stenosis or plaque complications) can be filed for each patient. Collateral circulation can be represented by identifying the site of origin, one or more mid-points on the pathway, and the point of contact with the recipient vessel. As many as 10 single pathways can be identified. The same method can represent and file by-pass grafting using different symbols. Data can be easily put into the computer in three to four minutes. Coding and filing are automatically stored. Ten Mb can contain 4355 reports, including patient data and five lines of optional comment. Data can be retrieved in the original graphic form or the system can analyze filed data and retrieve series of patients with a given angiographic pattern. This option enables comprehensive research to be performed on any patient population, selecting subgroups of patients with specific anatomic and/or pathologic characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed2005

[Efficacy and safety of a herbal drug containing hawthorn berries and D-camphor in hypotension and orthostatic circulatory disorders/results of a retrospective epidemiologic cohort study].

BACKGROUND AND OBJECTIVE: Korodin Herz-Kreislauf-Tropfen, a herbal drug containing D-camphor (CAS 76-22-2; 2.5 %) and a liquid extract of fresh hawthorn berries (97.3%), has been used since many years for the treatment of orthostatic hypotension. The combination as well as its constituents were tested in clinical trials against placebo with healthy volunteers and patients using tilt-tests. The objective of this study was to investigate efficacy and safety of the drug under the conditions of medical practice in comparison to other drugs admitted for this indication. PATIENTS AND METHODS: The study was performed as an epidemiological retrospective cohort study in 46 medical practices in Germany. In the practices the files were reviewed for patients who were treated between 1st January 2000 and 31st December 2002 for orthostatic hypotension. Included in the study were all patients who were treated either with the test drug or a control drug containing etilefrine, oxilofrine, midodrine, norfenefrine or dihydroergotamine and who met the inclusion criteria. The data of the files were coded, transferred to case report forms and augmented by the physician's statements about symptoms and success. Effect criteria were the improvement of symptoms and change of blood pressure during treatment. The correctness of the data was controlled using anonymous copies of the files. A total of 490 patients (399 in the test-group and 91 in the control group) between 11 and 102 years were included in the study. To correct heterogeneities in baseline conditions, treatment results were adjusted by regression and stratification to equal baseline conditions using the propensity score. RESULTS: The adjusted odds ratio for improvement was 5.6, the adjusted mean increase of the systolic blood pressure the 2-fold compared to the control group. The difference was highly significant and did not depend on age or initial blood pressure. In the test group two adverse events were observed which had no relation to the medication; in the control group one reversible event with a probable relation to the medication was observed. CONCLUSIONS: The test drug was proven as effective and safe in the treatment of orthostatic hypotension in medical practice for all age groups and independent of the initial blood pressures.

Adult↗
PubMed1991

Translating mainframe computer data to spreadsheet format.

The translation of mainframe-stored information in ASCII into spreadsheet format for use in Lotus 1-2-3 is explained. Details are presented on how to use the Data Parse command to create a translation template that tells Lotus 1-2-3 how to interpret a file written in ASCII. Lotus 1-2-3 can also translate some files in formats other than ASCII. It can translate files in the Data Interchange Format directly into its own format. Translating mainframe computer data into spreadsheet format is relatively simple and obviates the rekeying of those data.

Computers, Mainframe↗
PubMed1990

Overcoming potential pitfalls in the use of Medicare data for epidemiologic research.

We used Medicare data bases and US Census data to address two questions critical to the use of Medicare files for epidemiologic research. First, we examined the degree to which the population enrolled in the Medicare program is similar to the elderly resident population of the United States, as estimated by the US Census. We found small differences in the total population estimates but substantial differences by age and race. Second, we found that among Medicare enrollees, physician claims identify a small proportion of hip fracture cases which are not documented in the hospital discharge files. This proportion varies by age, region, and state within the United States. Calculation of rates based on Medicare hospital discharge data, and probably other hospital discharge data sets as well, must take these limitations into account. Use of all available Medicare data files can overcome these limitations.

Aged↗
PubMed2004

COLORADO3D, a web server for the visual analysis of protein structures.

COLORADO3D is a World Wide Web server for the visual presentation of three-dimensional (3D) protein structures. COLORADO3D indicates the presence of potential errors (detected by ANOLEA, PROSAII, PROVE or VERIFY3D), identifies buried residues and depicts sequence conservations. As input, the server takes a file of Protein Data Bank (PDB) coordinates and, optionally, a multiple sequence alignment. As output, the server returns a PDB-formatted file, replacing the B-factor column with values of the chosen parameter (structure quality, residue burial or conservation). Thus, the coordinates of the analyzed protein 'colored' by COLORADO3D can be conveniently displayed with structure viewers such as RASMOL in order to visualize the 3D clusters of regions with common features, which may not necessarily be adjacent to each other at the amino acid sequence level. In particular, COLORADO3D may serve as a tool to judge a structure's quality at various stages of the modeling and refinement (during both experimental structure determination and homology modeling). The GeneSilico group used COLORADO3D in the fifth Critical Assessment of Techniques for Protein Structure Prediction (CASP5) to successfully identify well-folded parts of preliminary homology models and to guide the refinement of misthreaded protein sequences. COLORADO3D is freely available for academic use at http://asia.genesilico.pl/colorado3d/.

Algorithms↗
PubMed1984

Admission predictors for pre-physical therapy majors.

This study was designed to determine whether a criterion exists for advisors to give students some indication early in their academic careers of their ultimate chances for admission to professional schools of physical therapy. Biographical questionnaires completed by pre-physical therapy students at Northern Illinois University provided materials for a descriptive study. Data obtained from files of successful and unsuccessful student applicants provided variables for a multiple-regression analysis. Results indicate that biographical data cannot be used to differentiate successful from unsuccessful applicants to professional programs. The only statistically significant variable tested that might be considered in advising students whether to remain in the major is their grade-point average at the end of the freshman year.

Educational Measurement↗