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1.
PLoS One ; 15(2): e0228545, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32045428

RESUMO

A key requirement for longitudinal studies using routinely-collected health data is to be able to measure what individuals are present in the datasets used, and over what time period. Individuals can enter and leave the covered population of administrative datasets for a variety of reasons, including both life events and characteristics of the datasets themselves. An automated, customizable method of determining individuals' presence was developed for the primary care dataset in Swansea University's SAIL Databank. The primary care dataset covers only a portion of Wales, with 76% of practices participating. The start and end date of the data varies by practice. Additionally, individuals can change practices or leave Wales. To address these issues, a two step process was developed. First, the period for which each practice had data available was calculated by measuring changes in the rate of events recorded over time. Second, the registration records for each individual were simplified. Anomalies such as short gaps and overlaps were resolved by applying a set of rules. The result of these two analyses was a cleaned set of records indicating start and end dates of available primary care data for each individual. Analysis of GP records showed that 91.0% of events occurred within periods calculated as having available data by the algorithm. 98.4% of those events were observed at the same practice of registration as that computed by the algorithm. A standardized method for solving this common problem has enabled faster development of studies using this data set. Using a rigorous, tested, standardized method of verifying presence in the study population will also positively influence the quality of research.


Assuntos
Coleta de Dados/métodos , Conjuntos de Dados como Assunto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Seguimentos , Registro Médico Coordenado , Algoritmos , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Coleta de Dados/normas , Bases de Dados Factuais , Conjuntos de Dados como Assunto/normas , Conjuntos de Dados como Assunto/estatística & dados numéricos , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Registro Médico Coordenado/normas , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Projetos de Pesquisa , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , País de Gales/epidemiologia , Varfarina/uso terapêutico
2.
Klin Monbl Augenheilkd ; 236(12): 1413-1417, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31805596

RESUMO

BACKGROUND: Transformation into a standardised code system such as ICD-10 or Alpha-ID is required before medical reports can be scientifically analysed. This is due to the use of different terminologies and the frequent use of synonyms. The so-called "word vector embedding" seems to be suitable for the generation of the required thesaurus, because synonymous diagnoses can be identified independently of the spelling - after suitable training of the underlying neural network. METHODS: All letters from a total of 50,000 patients were extracted anonymously. Diagnoses consisting of several words were merged into single words by means of phrase recognition and the "word2vec" model was trained on the text corpus of 352 megabytes. A total of 3742 diagnoses and ophthalmological interventions were extracted semi-automatically. The ophthalmological ICD and Alpha-ID codes were downloaded together with the official descriptions from the DIMDI website and the ophthalmological diagnoses/interventions were automatically linked with the nearest ICD- and Alpha-ID codes in the "word2vec" model. RESULTS: The "word2vec" model assigned 90% of the doctor's letter diagnoses correctly to appropriate ICD-10 codes. At the finer level of Alpha-ID, the rate of correct assignments was only 76%. The interventions were assigned to the correct indication in 92% of cases. Rare diseases, unusual designations and code degeneration in the official DIMDI file were identified as sources of error for incorrect or missing allocations. DISCUSSION: A diagnostic thesaurus can be generated with the "word2vec" method from a corpus of anonymised medical reports and the official Alpha-ID file from the DIMDI website. This thesaurus could be used for automatic extraction of diagnoses from doctor's letters in the future, given appropriate manual revision.


Assuntos
Classificação Internacional de Doenças , Registro Médico Coordenado , Humanos
3.
PLoS Med ; 16(9): e1002913, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31550245

RESUMO

BACKGROUND: Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. METHODS AND FINDINGS: A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias. CONCLUSIONS: Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.


Assuntos
Recesariana/efeitos adversos , Parto , Complicações na Gravidez/epidemiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Aleitamento Materno , Recesariana/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Registro Médico Coordenado , Alta do Paciente , Readmissão do Paciente , Morte Perinatal , Mortalidade Perinatal , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Escócia/epidemiologia , Fatores de Tempo , Nascimento Vaginal Após Cesárea/mortalidade
4.
Maturitas ; 129: 57-61, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31547914

RESUMO

OBJECTIVE: To examine the in-hospital mortality rate, and its risk factors, for patients with dementia admitted to hospital. STUDY DESIGN: We constructed an observational cohort study through data linkage of three Dutch national registers: the hospital discharge register (HDR), the population register (PR) and the national cause of death register. Patients with dementia in the HDR aged between 60 and 100 years registered between 1 January 2000 and 31 December 2010 were included. MAIN OUTCOME MEASURES: Risk factors for in-hospital mortality were investigated using multivariable Cox proportional hazard regression models that included sex, age, marital status, ethnicity, somatic comorbidity, type of dementia and urgency of admission. RESULTS: 40,500 patients were included in the cohort. The overall in-hospital mortality rate was 11.1%. Factors that significantly increased the mortality risk were: male sex (adjusted hazard ratio (HR) 1.52, 95%-confidence interval (95%-CI) 1.43-1.63), higher age (adjusted HR 1.03, 95%-CI 1.03-1.04), living with a partner (adjusted HR 1.39, 95%-CI 1.30-1.49), acute admission (adjusted HR 2.16, 95%-CI 1.97-2.36) and Alzheimer's disease (adjusted HR 1.21, 95%-CI 1.13-1.29). Cardiovascular disease was the most common cause of in-hospital mortality. CONCLUSIONS: This nationwide study found several independent risk factors for the in-hospital mortality of patients with dementia, including male sex, higher age, living with a partner, acute admission, and Alzheimer's disease. These risk factors should be taken into account by clinicians and caregivers as they will indicate whether patients are at risk of a more unfavourable outcome during hospital admission.


Assuntos
Doenças Cardiovasculares/mortalidade , Demência/mortalidade , Mortalidade Hospitalar , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/mortalidade , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Registro Médico Coordenado , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco , Fatores Sexuais
5.
Rev Bras Epidemiol ; 22: e190045, 2019 Sep 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31482984

RESUMO

INTRODUCTION: The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY: The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS: The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION: Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION: Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs.


Assuntos
Neoplasias da Mama/prevenção & controle , Sistemas de Informação em Saúde , Registro Médico Coordenado , Brasil , Bases de Dados Factuais , Feminino , Humanos , Mamografia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Integração de Sistemas
6.
Aust N Z J Public Health ; 43(5): 496-503, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31535432

RESUMO

OBJECTIVE: To provide insights into complexities of seeking access to state and federal cross-jurisdictional data for linkage with the Australian Childhood Immunisation Register (ACIR). We provide recommendations for improving access and receipt of linked datasets involving Australian Government-administered data. METHODS: We describe requirements for linking eleven federal and state data sources to establish a national linked dataset for safety evaluation of vaccines. The required data linkage methodology for integrating cross-jurisdictional data sources is also described. RESULTS: Extensive negotiation was required with 18 different agencies for 21 separate authorisations and 12 ethics approvals. Three variations of the 'best practice' linkage model were implemented. Australian Government approval requests spanned nearly four years from initial request for data, with a further year before ACIR data transfer to the linkage agency. CONCLUSIONS: Integration of immunisation registers with other data collections is achievable in Australia but infeasible for routine and rapid identification of vaccine safety concerns. Lengthy authorisation requirements, convoluted disparate application processes and inconsistencies in data supplied all contribute to delayed data availability. Implications for public health: Delayed data access for safety surveillance prevents timely epidemiological reviews. Poor responsiveness to safety concerns may erode public confidence, compromising effectiveness of vaccination programs through reduced participation.


Assuntos
Controle de Doenças Transmissíveis/estatística & dados numéricos , Coleta de Dados/legislação & jurisprudência , Imunização , Registro Médico Coordenado , Sistema de Registros , Vacinação/estatística & dados numéricos , Austrália , Criança , Humanos , Programas de Imunização , Formulação de Políticas , Vacinas
7.
BMC Health Serv Res ; 19(1): 567, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412854

RESUMO

BACKGROUND: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. METHODS: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. RESULTS: Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. CONCLUSIONS: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened. TRIAL REGISTRATION: ACTRN12610000297022 . Registered 13th April 2010.


Assuntos
Medicina Geral/organização & administração , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Austrália/epidemiologia , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Registro Médico Coordenado , Registros Médicos , Adulto Jovem
8.
Stud Health Technol Inform ; 264: 1781-1782, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438341

RESUMO

Differences in structure and semantics of data captured using screen forms in different Electronic Health Record (EHR) products and configurations is the root cause of many interoperability problems. We present a workaround enabling reuse of openEHR archetype and template semantics to configure forms in four surveyed, insufficiently standardized, EHR-products used in Sweden (Cerner Melior, Cerner Millenium, Cambio Cosmic and CGM TakeCare). Data from EHRs was then exported and queried using standardized query mechanisms.


Assuntos
Registros Eletrônicos de Saúde , Semântica , Sistemas Computacionais , Assistência à Saúde , Registro Médico Coordenado , Suécia
9.
BMC Health Serv Res ; 19(1): 526, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357992

RESUMO

BACKGROUND: Linking process of care data from general practice (GP) and hospital data may provide more information about the risk of hospital admission and re-admission for people with type-2 diabetes mellitus (T2DM). This study aimed to extract and link data from a hospital, a diabetes clinic (DC). A second aim was to determine whether the data could be used to predict hospital admission for people with T2DM. METHODS: Data were extracted using the GRHANITE™ extraction and linkage tool. The data from nine GPs and the DC included data from the two years prior to the hospital admission. The date of the first hospital admission for patients with one or more admissions was the index admission. For those patients without an admission, the census date 31/03/2014 was used in all outputs requiring results prior to an admission. Readmission was any admission following the index admission. The data were summarised to provide a comparison between two groups of patients: 1) Patients with a diagnosis of T2DM who had been treated at a GP and had a hospital admission and 2) Patients with a diagnosis of T2DM who had been treated at a GP and did not have a hospital admission. RESULTS: Data were extracted for 161,575 patients from the three data sources, 644 patients with T2DM had data linked between the GPs and the hospital. Of these, 170 also had data linked with the DC. Combining the data from the different data sources improved the overall data quality for some attributes particularly those attributes that were recorded consistently in the hospital admission data. The results from the modelling to predict hospital admission were plausible given the issues with data completeness. CONCLUSION: This project has established the methodology (tools and processes) to extract, link, aggregate and analyse data from general practices, hospital admission data and DC data. This study methodology involved the establishment of a comparator/control group from the same sites to compare and contrast the predictors of admission, addressing a limitation of most published risk stratification and admission prediction studies. Data completeness needs to be improved for this to be useful to predict hospital admissions.


Assuntos
Diabetes Mellitus Tipo 2 , Medicina Geral , Hospitalização , Registro Médico Coordenado , Adulto , Idoso , Instituições de Assistência Ambulatorial , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Sistemas de Informação Hospitalar , Humanos , Masculino , Sistemas Computadorizados de Registros Médicos , Pessoa de Meia-Idade , Observação , Adulto Jovem
11.
Eur J Epidemiol ; 34(9): 863-870, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187313

RESUMO

There are known short-term benefits in breastfed infants versus bottle-fed infants in terms of lower risks of infection and obesity in infancy and childhood, but the long-term effect on the risk of adult cancers is unclear. In a cohort of 1 in 4 UK women born in 1935-1950 we report the incidence of adult cancers in relation to having been breastfed in infancy. In median year 2001 (interquartile range 2000-2003) 548,741 women without prior cancer reported whether they had been breastfed. There was 81% agreement between women's report of having been breastfed and information on breastfeeding recorded when they were 2 years old. Participants were followed by record-linkage to national cancer registration, hospital admission and death databases. Cox regression yielded adjusted relative risks (RRs) and 95% confidence intervals (CI) by having been breastfed or not for eight cancer sites with > 2000 incident cases and for related conditions, where appropriate. Of the eight cancers examined here one association was highly statistically significant: an increase in colorectal cancer incidence among women who had been breastfed versus not (RR 1.18, 95% CI 1.12-1.24, n = 8651). To investigate further the findings for colorectal cancer, we studied eight other gastro-intestinal conditions, and found increased risks in women who had been breastfed versus not for benign colorectal polyps (RR 1.09, 95% CI 1.05-1.13, n = 17,677) and for appendicitis (RR 1.19, 95% CI 1.07-1.31, n = 2108). The greater risks of adult colorectal cancer, colorectal polyps and appendicitis associated with having been breastfed in infancy suggest possible long-term effects of infant feeding practices on the gastrointestinal tract. Further studies are required to clarify this novel association.


Assuntos
Aleitamento Materno , Neoplasias Colorretais/epidemiologia , Gastroenteropatias/epidemiologia , Obesidade/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comportamento Alimentar , Feminino , Humanos , Incidência , Lactente , Registro Médico Coordenado , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
12.
Cien Saude Colet ; 24(5): 1945-1958, 2019 May 30.
Artigo em Português | MEDLINE | ID: mdl-31166527

RESUMO

This study assesses the quality of the SIM and SINASC information systems in coverage, incompleteness and consistency aspects, as well as the contribution of the linkage for data retrieval. It includes all live births and infant deaths in Rio Grande do Sul from 2000 to 2014. The records were paired by deterministic linkage through the DNV number and, in its absence, by probabilistic linkage. SINASC's coverage rose from 72.2% in 2000 to 98.9%, namely a 37% increase in the number of matched records. All variables in SINASC presented excellent incompleteness throughout the period, except for the number of dead children and maternal occupation. SIM presented poor or very poor incompleteness for most of the variables until 2003. Although it improved, in 2014, six variables still presented regular or poor incompleteness. The linkage procedure greatly reduced the incompleteness for most variables. There was a great variability in terms of consistency: while for gender this percentage was over 97% throughout the period, for another five variables it was still less than 75% in 2014. SINASC presented high coverage level and excellent incompleteness. Problems related to consistency persist. This study shows the linkage technic efficiency to retrieve missing information.


Assuntos
Declaração de Nascimento , Atestado de Óbito , Sistemas de Informação/estatística & dados numéricos , Nascimento Vivo , Brasil , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Sistemas de Informação/normas , Masculino , Registro Médico Coordenado , Gravidez
13.
Stud Health Technol Inform ; 260: 200-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118338

RESUMO

In Austria, there is no single source of truth holding information about all physicians and their medical practice. Therefore, different sources have to be combined to accumulate detailed information about doctors, identify data errors and increase overall data quality. The aim of this project is to link two datasets from vastly different origins utilizing reproduceable and mostly automatic procedures in contrast to manually acquired links in the past. As there is no global identifier, names and addresses of the doctors were used instead. Because of different spellings and typos of names and addresses within and in between the datasets, direct comparison does not lead to satisfactory results. Therefore, probabilistic matching with string metrics was applied. The utilized methods significantly improve the linkage and allow to match about 80 % of the private consultants in both datasets.


Assuntos
Consultores , Registro Médico Coordenado , Padrões de Prática Médica , Áustria , Confiabilidade dos Dados , Humanos , Armazenamento e Recuperação da Informação , Prática Privada
14.
Stud Health Technol Inform ; 260: 210-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118340

RESUMO

BACKGROUND: Huge amounts of data are collected by healthcare providers and other institutions. However, there are data protection regulations, which limit their utilisation for secondary use, e.g. RESEARCH: In scenarios, where several data sources are obtained without universal identifiers, record linkage methods need to be applied to obtain a comprehensive dataset. OBJECTIVES: In this study, we had the objective to link two datasets comprising data from ergometric performance tests in order to have reference values to free text annotations for assessing their data quality. METHODS: We applied an iterative, distance-based time series record linkage algorithm to find corresponding entries in the two given datasets. Subsequently, we assessed the resulting matching rate. The implementation was done in Matlab. RESULTS: The matching rate of our record linkage algorithm was 74.5% for matching patients' records with their ergometry records. The highest rate of appropriate free text annotations was 87.9%. CONCLUSION: For the given scenario, our algorithm matched 74.5% of the patients. However, we had no gold standard for validating our results. Most of the free text annotations contained the expected values.


Assuntos
Confiabilidade dos Dados , Registros Eletrônicos de Saúde , Armazenamento e Recuperação da Informação , Registro Médico Coordenado , Algoritmos , Segurança Computacional , Humanos
15.
BMC Public Health ; 19(1): 595, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101093

RESUMO

BACKGROUND: Childhood epilepsy can adversely affect education and employment in addition to health. Previous studies are small or highly selective producing conflicting results. This retrospective cohort study aims to compare educational and health outcomes of children receiving antiepileptic medication versus peers. METHODS: Record linkage of Scotland-wide databases covering dispensed prescriptions, acute and psychiatric hospitalisations, maternity records, deaths, annual pupil census, school absences/exclusions, special educational needs, school examinations, and (un)employment provided data on 766,244 children attending Scottish schools between 2009 and 2013. Outcomes were adjusted for sociodemographic and maternity confounders and comorbid conditions. RESULTS: Compared with peers, children on antiepileptic medication were more likely to experience school absence (Incidence Rate Ratio [IRR] 1.43, 95% CI: 1.38, 1.48), special educational needs (Odds ratio [OR] 9.60, 95% CI: 9.02, 10.23), achieve the lowest level of attainment (OR 3.43, 95% CI: 2.74, 4.29) be unemployed (OR 1.82, 95% CI: 1.60, 2.07), be admitted to hospital (Hazard Ratio [HR] 3.56, 95% CI: 3.42, 3.70), and die (HR 22.02, 95% CI: 17.00, 28.53). Absenteeism partly explained poorer attainment and higher unemployment. Girls and younger children on antiepileptic medication had higher risk of poor outcomes. CONCLUSIONS: Children on antiepileptic medication fare worse than peers across educational and health outcomes. In order to reduce school absenteeism and mitigate its effects, children with epilepsy should receive integrated care from a multidisciplinary team that spans education and healthcare.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/epidemiologia , Hospitalização/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Absenteísmo , Adolescente , Adulto , Criança , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Escolaridade , Epilepsia/tratamento farmacológico , Feminino , Humanos , Masculino , Registro Médico Coordenado , Razão de Chances , Gravidez , Estudos Retrospectivos , Escócia/epidemiologia , Adulto Jovem
16.
Bull World Health Organ ; 97(4): 259-269, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940983

RESUMO

Objective: To evaluate the impact of the introduction of secondary civil registration centres on birth registrations within 60 days of birth, in Burkina Faso. Methods: The faith-based organization Sant'Egidio supported the inauguration of secondary birth registration centres within seven health centres in Réo from July 2015 and four health centres in Godyr from February 2015, at which delivery and vaccination services were available. We calculated the number of timely registrations per 1000 population before and after the launch of the intervention in both the intervention and control municipalities. We used a logistic regression model to evaluate the probability of non-registration as a function of the health centre services used and various demographic and health characteristics, obtained through health registers data and interviews. Findings: Compared with the previous 12 months, the number of timely birth registrations in Réo and Godyr rose from 502 to 2094 (317.1%) and from 267 to 793 (197.0%) during the first 12 months of the intervention. In the two control municipalities, the numbers were unchanged. Infants whose mothers attended health centres for delivery, but did not return for vaccinations, had the lowest proportions of birth registration (69.0%; 294/426; in Réo and 70.2%; 40/57 in Godyr). Infants of mothers who were not interviewed were more likely to not having a timely birth registration (in Réo odds ratio, OR: 6.25; 95% confidence interval, CI: 4.10-9.52 and in Godyr OR: 25.64; 95% CI: 4.31-166.67). Conclusion: Introduction of secondary registration centres within health centres increased timely birth registrations.


Assuntos
Declaração de Nascimento , Sistema de Registros/estatística & dados numéricos , Estatísticas Vitais , Adolescente , Adulto , Burkina Faso/epidemiologia , Feminino , Humanos , Lactente , Entrevistas como Assunto , Modelos Logísticos , Masculino , Registro Médico Coordenado , Mães , Gravidez , Vacinação/estatística & dados numéricos , Adulto Jovem
17.
JAMA ; 321(14): 1391-1399, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30964529

RESUMO

Importance: Data sets linking comprehensive genomic profiling (CGP) to clinical outcomes may accelerate precision medicine. Objective: To assess whether a database that combines EHR-derived clinical data with CGP can identify and extend associations in non-small cell lung cancer (NSCLC). Design, Setting, and Participants: Clinical data from EHRs were linked with CGP results for 28 998 patients from 275 US oncology practices. Among 4064 patients with NSCLC, exploratory associations between tumor genomics and patient characteristics with clinical outcomes were conducted, with data obtained between January 1, 2011, and January 1, 2018. Exposures: Tumor CGP, including presence of a driver alteration (a pathogenic or likely pathogenic alteration in a gene shown to drive tumor growth); tumor mutation burden (TMB), defined as the number of mutations per megabase; and clinical characteristics gathered from EHRs. Main Outcomes and Measures: Overall survival (OS), time receiving therapy, maximal therapy response (as documented by the treating physician in the EHR), and clinical benefit rate (fraction of patients with stable disease, partial response, or complete response) to therapy. Results: Among 4064 patients with NSCLC (median age, 66.0 years; 51.9% female), 3183 (78.3%) had a history of smoking, 3153 (77.6%) had nonsquamous cancer, and 871 (21.4%) had an alteration in EGFR, ALK, or ROS1 (701 [17.2%] with EGFR, 128 [3.1%] with ALK, and 42 [1.0%] with ROS1 alterations). There were 1946 deaths in 7 years. For patients with a driver alteration, improved OS was observed among those treated with (n = 575) vs not treated with (n = 560) targeted therapies (median, 18.6 months [95% CI, 15.2-21.7] vs 11.4 months [95% CI, 9.7-12.5] from advanced diagnosis; P < .001). TMB (in mutations/Mb) was significantly higher among smokers vs nonsmokers (8.7 [IQR, 4.4-14.8] vs 2.6 [IQR, 1.7-5.2]; P < .001) and significantly lower among patients with vs without an alteration in EGFR (3.5 [IQR, 1.76-6.1] vs 7.8 [IQR, 3.5-13.9]; P < .001), ALK (2.1 [IQR, 0.9-4.0] vs 7.0 [IQR, 3.5-13.0]; P < .001), RET (4.6 [IQR, 1.7-8.7] vs 7.0 [IQR, 2.6-13.0]; P = .004), or ROS1 (4.0 [IQR, 1.2-9.6] vs 7.0 [IQR, 2.6-13.0]; P = .03). In patients treated with anti-PD-1/PD-L1 therapies (n = 1290, 31.7%), TMB of 20 or more was significantly associated with improved OS from therapy initiation (16.8 months [95% CI, 11.6-24.9] vs 8.5 months [95% CI, 7.6-9.7]; P < .001), longer time receiving therapy (7.8 months [95% CI, 5.5-11.1] vs 3.3 months [95% CI, 2.8-3.7]; P < .001), and increased clinical benefit rate (80.7% vs 56.7%; P < .001) vs TMB less than 20. Conclusions and Relevance: Among patients with NSCLC included in a longitudinal database of clinical data linked to CGP results from routine care, exploratory analyses replicated previously described associations between clinical and genomic characteristics, between driver mutations and response to targeted therapy, and between TMB and response to immunotherapy. These findings demonstrate the feasibility of creating a clinicogenomic database derived from routine clinical experience and provide support for further research and discovery evaluating this approach in oncology.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Bases de Dados Genéticas , Registros Eletrônicos de Saúde , Imunoterapia , Neoplasias Pulmonares/genética , Mutação , Idoso , Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/terapia , Conjuntos de Dados como Assunto , Feminino , Perfilação da Expressão Gênica , Genômica , Genótipo , Humanos , Masculino , Registro Médico Coordenado , Pessoa de Meia-Idade , Medicina de Precisão , Receptor de Morte Celular Programada 1/análise
18.
West J Emerg Med ; 20(2): 342-350, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881555

RESUMO

Introduction: Early recognition and pre-notification by emergency medical services (EMS) improves the timeliness of emergency department (ED) stroke care; however, little is known regarding the effects on care should EMS providers fail to pre-notify. We sought to determine if potential stroke patients transported by EMS, but for whom EMS did not provide pre-notification, suffer delays in ED door-to-stroke-team activation (DTA) as compared to the other available cohort of patients for whom the ED is not pre-notified-those arriving by private vehicle. Methods: We queried our prospective stroke registry to identify consecutive stroke team activation patients over 12 months and retrospectively reviewed the electronic health record for each patient to validate registry data and abstract other clinical and operational data. We compared patients arriving by private vehicle to those arriving by EMS without pre-notification, and we employed a multivariable, penalized regression model to assess the probability of meeting the national DTA goal of ≤15 minutes, controlling for a variety of clinical factors. Results: Our inclusion criteria were met by 200 patients. Overall performance of the regression model was excellent (area under the curve 0.929). Arrival via EMS without pre-notification, compared to arrival by private vehicle, was associated with an adjusted risk ratio of 0.55 (95% confidence interval, 0.27-0.96) for achieving DTA ≤ 15 minutes. Conclusion: Our single-center data demonstrate that potential stroke patients arriving via EMS without pre-notification are less likely to meet the national DTA goal than patients arriving via other means. These data suggest a negative, unintended consequence of otherwise highly successful EMS efforts to improve stroke care, the root of which may be ED staff over-reliance on EMS for stroke recognition.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Serviços Médicos de Emergência , Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Registro Médico Coordenado , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Med Mal Infect ; 49(6): 447-455, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30914214

RESUMO

OBJECTIVES: Communication represents a key component of the control of highly drug-resistant bacteria (HDRB) in healthcare settings. This survey assessed communication strategies developed and adopted in a large hospital network. METHODS: An online survey was sent to 83 infection control specialists working in hospitals of the Pays de la Loire region, France, in June 2016. Internal and external systems of identification and communication of HDRB status (colonized and contact patients) were assessed at the following steps of the hospital pathway: patient admission, during the stay, at discharge, and at readmission. RESULTS: Sixty-one hospitals (73%) participated in the survey: 31 (51%) had recently managed colonized patients and 51 (93%) had recently managed contact patients. At patient admission, 28 (46%) hospitals had an identification system for repatriated patients. During hospital stay, the colonized or contact status was informed in computerized patient records for 47/57 (82%) and 43 (75%) hospitals, respectively. At patient discharge, 56/61 (92%) hospitals declared transmitting the HDRB status to the downstream ward. Twenty-six and 25/60 (43% and 42%) hospitals had an automated alert system at readmission of colonized or contact patients, respectively. This strategy met the expectations of 15/61 (26%) infection control specialists. CONCLUSION: Efforts are still required in terms of communication for HDRB control. Sharing experiences and tools developed by hospitals may be beneficial for the entire hospital network.


Assuntos
Gestão de Antimicrobianos , Farmacorresistência Bacteriana Múltipla , Hospitais , Controle de Infecções/organização & administração , Controle de Infecções/normas , Comunicação Interdisciplinar , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/normas , Comunicação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Estudos Transversais , França/epidemiologia , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/estatística & dados numéricos , Registro Médico Coordenado/métodos , Registro Médico Coordenado/normas , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/normas , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos
20.
PLoS One ; 14(3): e0214050, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921353

RESUMO

BACKGROUND: Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. METHODS: We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007-2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: Of the 10,259 maternal deaths recorded in 2007-2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. CONCLUSION: Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses.


Assuntos
Declaração de Nascimento , Bases de Dados Factuais , Atestado de Óbito , Registro Médico Coordenado , Adulto , Brasil/epidemiologia , Bases de Dados Factuais/estatística & dados numéricos , Dengue/complicações , Dengue/epidemiologia , Dengue/mortalidade , Feminino , Humanos , Recém-Nascido , Nascimento Vivo/epidemiologia , Masculino , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/mortalidade , Resultado da Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Sistema de Registros , Natimorto/epidemiologia
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