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2.
BMC Public Health ; 19(1): 1664, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829147

RESUMO

BACKGROUND: Tuberculosis is a leading cause of death worldwide and has become a high global health priority. Accurate country level surveillance is critical to ending the pandemic. Effective routine reporting systems which track the course of the epidemic are vital in addressing TB. China, which has the third largest TB epidemic in the world and has developed a reporting system to help with the control and prevention of TB, this study examined its effectiveness in Eastern China. METHODS: The number of TB cases reported internally in two hospitals in Eastern China were compared to the number TB cases reported by these same hospitals in the national reporting systems in order to assess the accuracy of reporting. Qualitative data from interviews with key health officials and researcher experience using the TB reporting systems were used to identify factors affecting the accuracy of TB cases being reported in the national systems. RESULTS: This study found that over a quarter of TB cases recorded in the internal hospital records were not entered into the national TB reporting systems, leading to an under representation of national TB cases. Factors associated with underreporting included unqualified and overworked health personnel, poor supervision and accountability at local and national levels, and a complicated incohesive health information management system. CONCLUSIONS: This study demonstrates that TB in Eastern China is being underreported. Given that Eastern China is a developed province, one could assume similar problems may be found in other parts of China with fewer resources as well as many low- and middle-income countries. Having an accurate account of the number of national TB cases is essential to understanding the national and global burden of the disease and in managing TB prevention and control efforts. As such, factors associated with underreporting need to be addressed in order to reduce underreporting.


Assuntos
Confiabilidade dos Dados , Notificação de Doenças/estatística & dados numéricos , Epidemias , Tuberculose/epidemiologia , China/epidemiologia , Registros Hospitalares/estatística & dados numéricos , Humanos
3.
Rev. esp. patol ; 52(2): 72-75, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182691

RESUMO

Introducción: Exponemos la necesidad de creación de registros de tumores hospitalarios para facilitar la explotación de datos epidemiológicos y el desarrollo de estrategias basadas en la prevención. Material y métodos: Análisis descriptivo retrospectivo de los datos del Registro de Tumores del Hospital La Paz recogiéndose la localización tumoral (CIE-O), método diagnóstico, estadio tumoral y tratamiento. Resultados: Se incluyeron un total de 1.987 casos. La edad media de diagnóstico fue de 66,2 años, el 53,3% de los casos correspondían a varones y el 46,7% a mujeres. Las localizaciones más frecuentes documentadas fueron el aparato digestivo, la piel, la mama y el aparato urinario. El método diagnóstico más frecuentemente usado fue la biopsia (83,1%), seguido de la citología (5,7%). En cuanto al estadio al diagnóstico el 84,5% de los casos se iniciaron como enfermedad localizada, mientras que el 15,4% como enfermedad diseminada. La cirugía fue el tratamiento más frecuente (78,8%) seguido de tratamiento sistémico (16,2%). Conclusión: La implantación de registros de tumores hospitalarios debería ser una prioridad sanitaria con el objetivo de obtener datos epidemiológicos que permitan un mejor conocimiento del cáncer en nuestro medio


Introduction: We present the case for the establishment of hospital tumour registries in order to facilitate the use of epidemiological data and the development of preventive policies. Material and methods: Retrospective descriptive analysis of the data of the tumour registry of the Hospital "La Paz" including tumoral location (ICD-O), diagnostic method, tumour grade and treatment. Results: 1987 cases were included. Median age at diagnosis was 66.2 years; 53.3% of cases were male and 46.7 female. The most frequent tumoral sites recorded were the digestive tract, skin, breast and urinary tract. The most common diagnostic method used was biopsy (83.1%), followed by cytology (5.7%). 84.5% of cases were originally recorded as localized disease, whilst 15.4% were disseminated. Surgery was the most common treatment (78.8%), followed by systemic therapy (16.2%). Conclusion: The establishment of hospital tumour registries should be prioritized, in order to collect epidemiological data which will enhance our understanding of cancer


Assuntos
Humanos , Registros de Doenças/estatística & dados numéricos , Neoplasias/epidemiologia , Registros Hospitalares/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/tendências , Distribuição por Idade e Sexo
4.
PLoS One ; 14(1): e0210214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30615653

RESUMO

People with serious mental illness die 10-25 years sooner than people without these conditions. Multiple challenges to accessing and benefitting from healthcare have been identified amongst this population, including a lack of coordination between mental health services and general health services. It has been identified in other conditions such as diabetes that accurate documentation of diagnosis in the primary care chart is associated with better quality of care. It is suspected that if a patient admitted to the hospital with serious mental illness is then discharged without adequate identification of their diagnosis in the primary care setting, follow up (such as medication management and care coordination) may be more difficult. We identified cohorts of patients with schizophrenia and bipolar disorder who accessed care through the North York Family Health Team (a group of 77 family physicians in Toronto, Canada) and North York General Hospital (a large community hospital) between January 1, 2012 and December 31, 2014. We identified whether labeling for these conditions was concordant between the two settings and explored predictors of concordant labeling. This was a retrospective cross-sectional study using de-identified data from the Health Databank Collaborative, a linked primary care-hospital database. We identified 168 patients with schizophrenia and 370 patients with bipolar disorder. Overall diagnostic concordance between primary care and hospital records was 23.2% for schizophrenia and 15.7% for bipolar disorder. Concordance was higher for those with multiple (2+) inpatient visits (for schizophrenia: OR 2.42; 95% CI 0.64-9.20 and for bipolar disorder: OR 8.38; 95% CI 3.16-22.22). Capture-recapture modeling estimated that 37.4% of patients with schizophrenia (95% CI 20.7-54.1) and 39.6% with bipolar disorder (95% CI 25.7-53.6) had missing labels in both settings when adjusting for patients' age, sex, income quintiles and co-morbidities. In this sample of patients accessing care at a large family health team and community hospital, concordance of diagnostic information about serious mental illness was low. Interventions should be developed to improve diagnosis and continuity of care across multiple settings.


Assuntos
Transtorno Bipolar/diagnóstico , Alta do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Esquizofrenia/diagnóstico , Adolescente , Adulto , Transtorno Bipolar/terapia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Registros Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos , Esquizofrenia/terapia , Adulto Jovem
5.
Cardiol Young ; 29(3): 290-296, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30683166

RESUMO

BACKGROUND: Outcome analyses in large administrative databases are ideal for rare diseases such as Becker and Duchenne muscular dystrophy. Unfortunately, Becker and Duchenne do not yet have specific International Classification of Disease-9/-10 codes. We hypothesised that an algorithm could accurately identify these patients within administrative data and improve assessment of cardiovascular morbidity. METHODS: Hospital discharges (n=13,189) for patients with muscular dystrophy classified by International Classification of Disease-9 code: 359.1 were identified from the Pediatric Health Information System database. An identification algorithm was created and then validated at three institutions. Multi-variable generalised linear mixed-effects models were used to estimate the associations of length of stay, hospitalisation cost, and 14-day readmission with age, encounter severity, and respiratory disease accounting for clustering within the hospital. RESULTS: The identification algorithm improved identification of patients with Becker and Duchenne from 55% (code 359.1 alone) to 77%. On bi-variate analysis, left ventricular dysfunction and arrhythmia were associated with increased cost of hospitalisation, length of stay, and mortality (p<0.001). After adjustment, Becker and Duchenne patients with left ventricular dysfunction and arrhythmia had increased length of stay with rate ratio 1.4 and 1.2 (p<0.001 and p=0.004) and increased cost of hospitalization with rate ratio 1.4 and 1.4 (both p<0.001). CONCLUSIONS: Our algorithm accurately identifies patients with Becker and Duchenne and can be used for future analysis of administrative data. Our analysis demonstrates the significant effects of cardiovascular disease on length of stay and hospitalisation cost in patients with Becker and Duchenne. Better recognition of the contribution of cardiovascular disease during hospitalisation with earlier more intensive evaluation and therapy may help improve outcomes in this patient population.


Assuntos
Algoritmos , Doenças Cardiovasculares/epidemiologia , Custos Hospitalares , Registros Hospitalares/estatística & dados numéricos , Hospitalização/tendências , Distrofia Muscular de Duchenne/complicações , Medição de Risco/métodos , Adolescente , Doenças Cardiovasculares/etiologia , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Morbidade/tendências , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estados Unidos/epidemiologia
6.
Vaccine ; 37(1): 41-48, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30478004

RESUMO

BACKGROUND: Vaccine-preventable invasive bacterial diseases (IBDs) caused by Neisseria meningitidis (Nm), Streptococcus pneumoniae (Sp), and Haemophilus influenzae (Hi) have been notified in Italy since 2007 without assessing reporting completeness. METHODS: Our study compared the number of cases of IBDs identified from the Italian Hospital Discharge Records (HDRs), using specific diagnostic ICD-9-CM codes, with those notified to the National Surveillance System (NSS) from 2007 to 2016. A multinomial logistic regression model was used to impute the aetiology of all discharges with a diagnosis of unspecified bacterial meningitis. RESULTS: Over a 10-year period, 14,243 hospital discharges with diagnosis of IBD were estimated in Italy (12,671 with specified aetiology and 1,572 with imputed aetiology). Among those, 2,513 (17.6%) were caused by Nm, 10,441 (73.3%) by Sp, and 1289 (9.1%) by Hi. Most invasive meningococcal diseases were coded as meningitis (72.3%), while Hi and Sp were more frequently coded as septicaemia (51.6% and 60.4%, respectively). The highest mean annual incidence rate was found for IBD caused by Sp (1.74 per 100,000), followed by Nm (0.42 per 100,000) and by Hi (0.21 per 100,000). Comparing NSS with HDR data, we found an initially high underreporting of all IBDs, and particularly for Hi. Data from the two systems overlapped in more recent years, due to an improved reporting completeness. The increasing IBD incidence observed in NSS data was not confirmed by HDR data trends, although with pathogen-related differences with Hi cases rising in both data sources, suggesting that is mainly due to an improved disease notification rather than to a true incidence increase. CONCLUSIONS: Comparing surveillance data with other data sources is useful to better interpret observed trends of notifiable diseases.


Assuntos
Infecções Bacterianas/epidemiologia , Monitoramento Epidemiológico , Registros Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Infecções por Haemophilus/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Meningite por Haemophilus/epidemiologia , Meningite Meningocócica/epidemiologia , Meningite Pneumocócica/epidemiologia , Infecções Meningocócicas/epidemiologia , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Análise de Regressão , Adulto Jovem
7.
Early Hum Dev ; 129: 103-105, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30545723

RESUMO

INTRODUCTION: The requirement for medical services fluctuates. This study was carried out in order to attempt to extrapolate the service requirements for various cardiology services at Mater Dei Hospital, Malta over the coming five years, based on service demands from previous years. METHODS: Past annual data was obtained from hospital records for various services (to 2017). Linear regression was carried out using a bespoke Excel™ spreadsheet in order to extrapolate possible services requirements up to 2022. RESULTS: All services are expected to increase, with forecasts ranging between 41 and 354%, depending on services being considered. DISCUSSION: It is easy to "get on with it" and perform the work required at the workplace but this study has shown that it is equally important to anticipate demands lest lack of planning leads to long and important waiting lists for critical diagnostics and treatments. Health care provision requirements are increasing worldwide. Even using conservative estimates and in the absence of the creation of new services, the demands for extant services are likely to continue to grow. Unless medium term plans are made for hardware, software, physical space and staffing, and the funding thereof, waiting lists for investigations in this speciality are bound to rise. This may be mitigated by novel treatments but since these cannot be predicted, it would be safer and wiser to plan ahead lest we are overwhelmed. This paper has also shown how WASP (Write a Scientific Paper) precepts can be applied to elegantly study a problem and write up a paper.


Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Escrita Médica/normas , Bioestatística/métodos , Serviço Hospitalar de Cardiologia/normas , Serviço Hospitalar de Cardiologia/tendências , Conjuntos de Dados como Assunto , Registros Hospitalares/estatística & dados numéricos , Malta
8.
BMJ Open ; 8(12): e022939, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30530474

RESUMO

OBJECTIVES: There are no established mortality risk equations specifically for emergency medical patients who are admitted to a general hospital ward. Such risk equations may be useful in supporting the clinical decision-making process. We aim to develop and externally validate a computer-aided risk of mortality (CARM) score by combining the first electronically recorded vital signs and blood test results for emergency medical admissions. DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (Northern Lincolnshire and Goole NHS Foundation Trust Hospital (NH)-model development data; York Hospital (YH)-external validation data). PARTICIPANTS: Adult (aged ≥16 years) medical admissions discharged over a 24-month period with electronic National Early Warning Score(s) and blood test results recorded on admission. RESULTS: The risk of in-hospital mortality following emergency medical admission was 5.7% (NH: 1766/30 996) and 6.5% (YH: 1703/26 247). The C-statistic for the CARM score in NH was 0.87 (95% CI 0.86 to 0.88) and was similar in an external hospital setting YH (0.86, 95% CI 0.85 to 0.87) and the calibration slope included 1 (0.97, 95% CI 0.94 to 1.00). CONCLUSIONS: We have developed a novel, externally validated CARM score with good performance characteristics for estimating the risk of in-hospital mortality following an emergency medical admission using the patient's first, electronically recorded, vital signs and blood test results. Since the CARM score places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.


Assuntos
Doença Aguda/mortalidade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Testes Hematológicos/estatística & dados numéricos , Mortalidade Hospitalar , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Sinais Vitais , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Registros Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Estatal/estatística & dados numéricos , Reino Unido
9.
Rev Soc Bras Med Trop ; 51(6): 831-835, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517539

RESUMO

INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.


Assuntos
Doença de Chagas , Registros Hospitalares/estatística & dados numéricos , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Doença de Chagas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
10.
Health Rep ; 29(8): 3-8, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-30110507

RESUMO

BACKGROUND: National population information about the surgical treatment rate for primary cancers, including breast cancer, has remained a significant data gap in Canada. This gap has implications for cancer care planning and evaluating health system performance. New linkages between the Canadian Cancer Registry and hospital discharge records were conducted by Statistics Canada in 2016. Using already existing, routinely collected health administrative data, these linkages allow viable reporting of surgical cancer treatment for the first time for all provinces and territories (except Quebec). DATA AND METHODS: Hospital record information about type and date of surgical treatment of tumours was provided by information from linked data. These linked data reported 50,740 incident primary malignant breast tumours diagnosed between January 1, 2010, and December 31, 2012, among females aged 19 years or older. The unadjusted treatment rate for primary surgical intervention within one year was calculated as the proportion of total tumours that were linkable to hospital records. RESULTS: For three combined years (2010, 2011 and 2012), 88.3% (N=44,780) of patients overall received at least one surgical treatment. Variations to the surgical rate occurred across jurisdictions, with the highest rate at 91-92% for Prince Edward Island, Newfoundland and Labrador, British Columbia and New Brunswick. Generally, there was an inverse gradient between surgical treatment rate and tumour stage. DISCUSSION: The surgical treatment rate of new primary breast cancers varied across provinces and territories from 2010 to 2012. New linked data could be used to further identify geographic and demographic inequities in terms of receiving surgical cancer treatment and contribute to the evaluation of cancer system performance and outcomes.


Assuntos
Neoplasias da Mama/cirurgia , Armazenamento e Recuperação da Informação/métodos , Alta do Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adulto , Canadá/epidemiologia , Feminino , Registros Hospitalares/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Adulto Jovem
11.
PLoS One ; 13(6): e0198183, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29902220

RESUMO

BACKGROUND: Maternity care has to be available 24 hours a day, seven days a week. It is known that obstetric intervention can influence the time of birth, but no previous analysis at a national level in England has yet investigated in detail the ways in which the day and time of birth varies by onset of labour and mode of giving birth. METHOD: We linked data from birth registration, birth notification, and Maternity Hospital Episode Statistics and analysed 5,093,615 singleton births in NHS maternity units in England from 2005 to 2014. We used descriptive statistics and negative binomial regression models with harmonic terms to establish how patterns of timing of birth vary by onset of labour, mode of giving birth and gestational age. RESULTS: The timing of birth by time of day and day of the week varies considerably by onset of labour and mode of birth. Spontaneous births after spontaneous onset are more likely to occur between midnight and 6am than at other times of day, and are also slightly more likely on weekdays than at weekends and on public holidays. Elective caesarean births are concentrated onto weekday mornings. Births after induced labours are more likely to occur at hours around midnight on Tuesdays to Saturdays and on days before a public holiday period, than on Sundays, Mondays and during or just after a public holiday. CONCLUSION: The timing of births varies by onset of labour and mode of birth and these patterns have implications for midwifery and medical staffing. Further research is needed to understand the processes behind these findings.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Início do Trabalho de Parto/fisiologia , Parto/fisiologia , Declaração de Nascimento , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Registros Hospitalares/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Erros Médicos/estatística & dados numéricos , Registro Médico Coordenado/métodos , Gravidez , Fatores de Tempo
12.
BMC Med Res Methodol ; 18(1): 43, 2018 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-29776431

RESUMO

BACKGROUND: Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. METHODS: This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). RESULTS: The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. CONCLUSIONS: Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.


Assuntos
Autopsia/métodos , Causas de Morte , Registros Hospitalares/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Vietnã
13.
BMC Health Serv Res ; 18(1): 292, 2018 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-29678172

RESUMO

BACKGROUND: Hospitalization due to dengue illness is an important measure of dengue morbidity. However, limited studies are based on administrative database because the validity of the diagnosis codes is unknown. We validated the International Classification of Diseases, 10th revision (ICD) diagnosis coding for dengue infections in the Malaysian Ministry of Health's (MOH) hospital discharge database. METHODS: This validation study involves retrospective review of available hospital discharge records and hand-search medical records for years 2010 and 2013. We randomly selected 3219 hospital discharge records coded with dengue and non-dengue infections as their discharge diagnoses from the national hospital discharge database. We then randomly sampled 216 and 144 records for patients with and without codes for dengue respectively, in keeping with their relative frequency in the MOH database, for chart review. The ICD codes for dengue were validated against lab-based diagnostic standard (NS1 or IgM). RESULTS: The ICD-10-CM codes for dengue had a sensitivity of 94%, modest specificity of 83%, positive predictive value of 87% and negative predictive value 92%. These results were stable between 2010 and 2013. However, its specificity decreased substantially when patients manifested with bleeding or low platelet count. CONCLUSION: The diagnostic performance of the ICD codes for dengue in the MOH's hospital discharge database is adequate for use in health services research on dengue.


Assuntos
Dengue/classificação , Registros Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Classificação Internacional de Doenças , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Dengue/epidemiologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Epidemiol Prev ; 42(1): 34-39, 2018.
Artigo em Italiano | MEDLINE | ID: mdl-29506359

RESUMO

OBJECTIVES: to explore clinicians vision on hospital discharge records in order to identify useful elements to foster a more accurate compiling. DESIGN: qualitative research with phenomenological approach. SETTING AND PARTICIPANTS: participants were selected through purposive sampling among clinicians of two hospitals located in Sardinia; the sample included 76 people (32 medical directors and 44 doctors in training). MAIN OUTCOME MEASURES: identified codes for themes under investigation: vision of accurate compiling, difficulties, and proposals. RESULTS: collected data highlighted two prevailing visions, respectively focused on the importance of an accurate compiling and on the burden of such activity. The accurate compiling is hindered by the lack of motivation and training, by the limits of the registration system and the information technology, by the distortions induced by the prominent role of the hospital discharge records in the evaluation processes. Training, timely updating of the information system accompanied by a proper cross-cultural validation process, improvement of the computer system, and activation of support services could promote more accurate compiling. CONCLUSIONS: the implementation of services, unconnected with evaluation and control processes, dedicated to training and support in the compiling of the hospital discharge records and in the conduction of related epidemiological studies would facilitate the compliance to the compilation. Such services will make tangible the benefits obtainable from this registration system, increasing skills, motivation, ownership, and facilitating greater accuracy in compiling.


Assuntos
Coleta de Dados/métodos , Registros Hospitalares , Corpo Clínico Hospitalar/psicologia , Alta do Paciente , Diretores Médicos/psicologia , Confiabilidade dos Dados , Registros Eletrônicos de Saúde , Registros Hospitalares/estatística & dados numéricos , Humanos , Itália , Administradores de Registros Médicos/educação , Motivação , Alta do Paciente/estatística & dados numéricos , Pesquisa Qualitativa
15.
BMJ Open ; 8(3): e017898, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29500200

RESUMO

OBJECTIVES: To quality assure a Trusted Third Party linked data set to prepare it for analysis. SETTING: Birth registration and notification records from the Office for National Statistics for all births in England 2005-2014 linked to Maternity Hospital Episode Statistics (HES) delivery records by NHS Digital using mothers' identifiers. PARTICIPANTS: All 6 676 912 births that occurred in England from 1 January 2005 to 31 December 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Every link between a registered birth and an HES delivery record for the study period was categorised as either the same baby or a different baby to the same mother, or as a wrong link, by comparing common baby data items and valid values in key fields with stepwise deterministic rules. Rates of preserved and discarded links were calculated and which features were more common in each group were assessed. RESULTS: Ninety-eight per cent of births originally linked to HES were left with one preserved link. The majority of discarded links were due to duplicate HES delivery records. Of the 4854 discarded links categorised as wrong links, clerical checks found 85% were false-positives links, 13% were quality assurance false negatives and 2% were undeterminable. Births linked using a less reliable stage of the linkage algorithm, births at home and in the London region, and with birth weight or gestational age values missing in HES were more likely to have all links discarded. CONCLUSIONS: Linkage error, data quality issues, and false negatives in the quality assurance procedure were uncovered. The procedure could be improved by allowing for transposition in date fields, and more discrimination between missing and differing values. The availability of identifiers in the datasets supported clerical checking. Other research using Trusted Third Party linkage should not assume the linked dataset is error-free or optimised for their analysis, and allow sufficient resources for this.


Assuntos
Confiabilidade dos Dados , Registros Hospitalares/estatística & dados numéricos , Maternidades , Registro Médico Coordenado/normas , Prole de Múltiplos Nascimentos , Parto , Adulto , Peso ao Nascer , Inglaterra , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Garantia da Qualidade dos Cuidados de Saúde/organização & administração
16.
Matern Child Health J ; 22(6): 858-865, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29435783

RESUMO

Introduction Researchers in perinatal health, as well as other areas, may be interested in linking existing datasets to vital records data when the existence or timing of births is unknown. Methods 5914 women who participated in the Bogalusa Heart Study (1973-2009), a long-running study of cardiovascular health in childhood, adolescence, and adulthood, were linked to vital statistics birth data from Louisiana, Mississippi, and Texas (1982-2010). Deterministic and probabilistic linkages based on social security number, race, maternal date of birth, first name, last name, and Soundex codes for name were conducted. Characteristics of the linked and unlinked women were compared using t-tests, Chi square tests, and multiple regression with adjustment for age and year of examinations. Results The Louisiana linkage linked 4876 births for 2770 women; Mississippi linked 791 births to 487 women; Texas linked 223 births to 153 women; After removal of duplicates and implausible dates, this left a total of 5922 births to 3260 women. This represents a successful linkage of 55% of all women ever seen in the larger study, and an estimated 65% of all women expected to have given birth. Those linked had more study visits, were more likely to be black, and had statistically lower BMIs than unlinked participants. Discussion Linking unrelated study data to vital records data was feasible to a degree. The linked group had a somewhat more favorable health profile and was less mobile than the overall study population.


Assuntos
Declaração de Nascimento , Coleta de Dados , Registros Hospitalares/estatística & dados numéricos , Registro Médico Coordenado/métodos , Estatísticas Vitais , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Louisiana , Mississippi , Gravidez , Texas
17.
J Epidemiol Community Health ; 72(4): 331-336, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29437877

RESUMO

BACKGROUND: Dog bite studies are typically based on hospital records and may be biased towards bites requiring significant medical treatment. This study investigated true dog bite prevalence and incidence at a community-level and victim-related risk factors, in order to inform policy and prevention. METHODS: A cross-sectional study of a community of 1280 households in Cheshire, UK, surveyed 694 respondents in 385 households. Data included dog ownership and bite history, demographics, health and personality (Ten Item Personality Inventory (TIPI) brief measure). Multivariable logistic regression modelled risk factors for having ever been bitten by a dog, accounting for clustering of individuals within households. RESULTS: A quarter of participants (24.78%, 95% CI 21.72 to 28.13) reported having ever been bitten by a dog during their lifetime, with only a third of bites described requiring further medical treatment and 0.6% hospital admission. Incidence of dog bites was 18.7 (11.0-31.8) per 1000 population per year. Males were 1.81 times more likely to have been bitten in their lifetime than females (95% CI 1.20 to 2.72, P=0.005). Current owners of multiple dogs were 3.3 times more likely (95% CI 1.13 to 9.69, P=0.03) to report having been bitten than people not currently owning a dog. Regarding all bites described, most commonly people were bitten by a dog that they had never met before the incident (54.7%). Individuals scoring higher in emotional stability had a lower risk of having ever been bitten (OR=0.77 for 1 point change in scale between 1 and 7, 95% CI 0.66 to 0.9, P=0.001). CONCLUSION: This study suggests that the real burden of dog bites is considerably larger than those estimated from hospital records. Further, many bites do not require medical treatment and hospital-based bite data are not representative of bites within the wider population. Victim personality requires further investigation and potential consideration in the design of bite prevention schemes.


Assuntos
Mordeduras e Picadas/epidemiologia , Registros Hospitalares/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Acidentes , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Estudos Transversais , Cães , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Reino Unido/epidemiologia , Adulto Jovem
18.
Clin Med (Lond) ; 18(1): 47-53, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29436439

RESUMO

Hospital-acquired acute kidney injury (H-AKI) is a common cause of avoidable morbidity and mortality. Therefore, in the current study, we investigated whether vital signs data from patients, as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. We analysed all emergency admissions (n=33,608) to York Hospital with NEWS data over a 24-month period. Here, we report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3), and similarly for maximum NEWS (models B0,B1,B2,B3). Of the total emergency admissions, 4.05% (1,361/33,608) had H-AKI. Models using the index NEWS had lower AUCs (0.59-0.68) than models using the maximum NEWS AUCs (0.75-0.77). The maximum NEWS model (B3) was more sensitive than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Based on these results, we suggest that the index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but appears to be unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload, albeit with improved sensitivity.


Assuntos
Lesão Renal Aguda , Serviço Hospitalar de Emergência/estatística & dados numéricos , Registros Hospitalares/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Medição de Risco/métodos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Idoso , Emergências/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Projetos de Pesquisa/normas , Fatores de Tempo , Reino Unido/epidemiologia
19.
Eur Heart J Qual Care Clin Outcomes ; 4(3): 155-167, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29462281

RESUMO

Aims: To implement secondary care electronic record linkage for patients hospitalized with suspected or known acute coronary syndrome (ACS) in a complex regional health care system and evaluate this e-Registry in terms of patterns of service delivery and 1-year outcomes. Methods and results: Existing electronic hospital records were linked to create episodes of care using (i) a patient administration system, (ii) invasive cardiovascular procedure referrals, and (iii) a catheter laboratory record. Data were extracted for admissions (1 October 2013-30 September 2014) with International Classification of Disease (ICD)-10 diagnosis of angina (I200-I209), myocardial infarction (I210-I229), other ischaemic heart disease (I240-I249) or heart failure (I50), linked to other sources to develop a secondary care ACS e-registry and analysed within a Safe Haven. Episodes of care were categorized into care pathways and evaluated in terms of patient characteristics, as well as service delivery metrics and outcomes including mortality. In all, 2327 patients had 2472 episodes of care. Diagnoses were hierarchically classified as ST-elevation myocardial infarction (STEMI) (586, 25.2%), non-ST-elevation myocardial infarction (NSTEMI) (1068, 45.9%), unspecified myocardial infarction (146, 6.3%), unstable angina (527, 22.6%) for the first hospitalization for each patient within the study period. Six care pathways were mapped. Percutaneous coronary intervention rate for STEMI was 80.2% and for NSTEMI 33.1%. Unadjusted all-cause mortality was 9.0% and 3.0% for STEMI and NSTEMI at 30 days, rising to 11.9% and 11.6% at 1 year. Analyses were validated by independent source data verification. Conclusion: The e-registry has enabled analysis of ACS hospitalizations in a complex health care system with implications for quality improvement and research.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Registros Hospitalares/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Sistema de Registros , Atenção Secundária à Saúde/estatística & dados numéricos , Síndrome Coronariana Aguda/epidemiologia , Idoso , Causas de Morte/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escócia/epidemiologia , Taxa de Sobrevida/tendências
20.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 53(1): 15-18, ene.-feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-169805

RESUMO

Objetivos. La Comisión Contra la Violencia del Hospital Clínico San Carlos (Madrid) puso en marcha en 2012 un plan integral de detección y seguimiento de los casos de sospecha de malos tratos al adulto mediante un registro hospitalario. En este estudio se valoran los resultados de los primeros 3años analizando las diferencias en función de la edad (menores y mayores de 65años). Material y métodos. De acuerdo con el registro se han comparado los resultados de mayores y menores de 65años relativos a: sexo, lugar del registro, responsable de la notificación, historia de violencia previa, tipo de maltrato, recursos empleados y seguimiento. También se recogió la tasa de fallecidos en el primer año. El procesamiento y análisis de los datos se realizó mediante el paquete estadístico SPSS 18.0. Resultados. El número registrado de casos de sospecha durante los 3años (2013-2015) fue de 172. GrupoA (15-64años): 140 casos. GrupoB (>65años): 32 (22,8%). Sexo: GrupoA: 93,5% mujeres. GrupoB: 78,1% (p=0,014). Lugar del registro: GrupoA: urgencias: 90,7%, hospitalización: 6,4%, consultas externas: 3,0%. GrupoB: urgencias: 65,6%, hospitalización: 31,6%, consultas externas: 2,8% (p=0,001). Notificación: Grupo A: trabajador social: 25%, médico: 67,8%, enfermera: 6,4%. Grupo B: trabajador social: 65,2%, médico: 28,1, enfermera: 6,2. (p<0,001). Historia de violencia previa: GrupoA: 62,1%. GrupoB: 68,7%. Tipo de maltratos: GrupoA: físicos: 56,4%, psíquicos: 2,8%, físicos +psíquicos: 30,4%, físicos +psíquicos +económicos: 10,1%. GrupoB: físicos: 31,1%, psíquicos: 5,1%, negligencia: 18,7%, físicos +psíquicos: 10,1, físicos +psíquicos +económicos: 9,8, económicos: 25,1 (p<0,0001). Recursos empleados y seguimiento: Parte de lesiones: GrupoA: 63,5%. GrupoB: 31,2% (p=0,001). Medidas de protección judicial: GrupoA: 12,8. GrupoB: 15,6 (p=0,773). Orden de alejamiento: GrupoA: 2,1. GrupoB: 6,25 (p=0,235). Fallecieron al año de seguimiento más de un tercio de los pacientes del grupoB y ningún paciente en el grupoA. Conclusiones. La urgencia médica es el lugar donde más se detecta el problema. Existe historia de violencia previa en más de la mitad de los casos en ambos grupos de edad. Retrato robot de la víctima: mujer anciana, con importante deterioro físico y cognitivo. El abuso económico y la negligencia son más frecuentes en la población anciana. En nuestra serie fallecen al año más de un tercio de los pacientes ancianos víctimas de malos tratos. El registro hospitalario es fundamental para la detección y el seguimiento del maltrato en el anciano (AU)


Objectives. The Hospital Clínico San Carlos Committee against violence established a protocol in 2012 in order to detect and follow-up violence against elderly persons. This article presents the experience after 3years of its introduction, as well as an analysis comparing the differences between those younger and older than 65years of age. Material and methods. All cases were collected during years 2013, 2014, and 2015, and were divided into two groups, A and B, according to age, younger or older than 65years. Parameters studied were: gender, place of detection (emergency department, during hospital admission, or outpatient clinics), type of professional worker who detected each case (social workers, nurses, or physicians), previous history of violence, type of aggression (physical, psychological, financial), institutional procedures once aggression was confirmed, and deaths after one year of follow-up. The SPPS v.18.0 package was used for the statistical analysis. Results. A total of 172 cases were detected, of which 140 of them were included in groupA (<65years), and 32 in groupB (>65 years, 22.8%). Gender: GroupA: women: 93.5%. GroupB: women: 78.1% (P=.014). Registration site: GroupA: emergency department: 90.7%, hospital wards: 6.4%, outpatient wards: 3.0. GroupB: emergency department: 65.6%, hospital wards: 31.6%, outpatient wards: 2.8% (P=.001). Notification: GroupA: social worker: 25%, physician: 67.8%, nurse: 6.4%. GroupB: social worker: 65.2%, physician: 28.1%, nurse: 6.2% (P<.001). Previous violence history: GroupA: 62.1%. GroupB: 68.7%. Type of abuse: GroupA: physical: 56.4%, psychological: 2.8%, physical +psychological: 30.4%, physical +psychological +economic: 10.1%. GroupB: physical: 31.1%, psychological: 5.1%, neglect: 18.7%, physical +psychological: 10.1, physical +psychological +economic: 9.8, economic: 25.1 (P<.0001). Resources employed and follow-up: Injuries: Group A: 63.5%. Group B: 31.2% (P=.001). Judicial protection measures: GroupA: 12.8. GroupB: 15.6 (P=.773). Removal order: GroupA: 2.1. GroupB: 6.25 (P=.235). More than one-third of patients in groupB, and none of the patients in groupA, died in the year of follow-up. Conclusions. There are more problems detected in the Emergency Department. There is a history of previous violence in more than half of the cases in both age groups. The profile of the victim is an elderly woman with significant physical and cognitive impairment. Economic abuse and neglect are more frequent in the elderly population. In our series, more than one-third of elderly patients who are victims of ill-treatment die each year. The hospital registry is fundamental for the detection and follow-up of abuse in the elderly (AU)


Assuntos
Humanos , Idoso , Maus-Tratos ao Idoso/estatística & dados numéricos , Registros Hospitalares/estatística & dados numéricos , Atenção Terciária à Saúde/métodos , Notificação de Abuso , Distribuição por Idade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Avaliação Geriátrica/métodos
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