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The number of frail elderly will increase as the world population ageing accelerates. Since frail elders are at risk of falls, hospitalizations and disabilities, they will require more health care and services. To assess frailty p...
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The number of frail elderly will increase as the world population ageing accelerates. Since frail elders are at risk of falls, hospitalizations and disabilities, they will require more health care and services. To assess frailty prevalence using health administrative databases, to examine the association between frailty and the use of medical services and to measure the excess use of health services following a non-hip fracture across frailty levels among community-dwelling seniors. A population-based cohort study was built from the Quebec Integrated Chronic Disease Surveillance System, including men and women ≥65?years old, non-institutionalized in the pre-fracture year. Frailty was measured using the Elders Risk Assessment (ERA) index. Multivariate Generalized Estimating Equation models were used to examine the relationship between frailty levels and health services while adjusting for covariates. The excess numbers of visits to Emergency Departments (ED) and to Primary Care Practitioners (PCP) as well as hospitalizations were also estimated. The cohort included 178,304 fractures. There were 13.6 and 5.2% frail and robust seniors, respectively. In the post-fracture year, the risks of ED visits, PCP visits and hospitalizations, were significantly higher in frail vs. non-frail seniors: adjusted relative risk (RR)?=?2.69 [95% CI: 2.50-2.90] for ED visits, RR?=?1.28 [95% CI: 1.23-1.32] for PCP visits and RR?=?2.34 [95% CI: 2.14-2.55] for hospitalizations. Our results suggest that it is possible to characterize seniors' frailty status at a population level using health administrative databases. Furthermore, this study shows that non-institutionalized frail seniors require more health services after an incident fracture. Screening for frailty in seniors should be part of clinical management in order to identify those at a higher risk of needing health services.
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High-dimensional databases pose a challenge withrespect to efficient access. High-dimensional indexes do notwork because of the oft-cited "curse of dimensionality''. However, users are usually interested in querying data over a re...
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High-dimensional databases pose a challenge withrespect to efficient access. High-dimensional indexes do notwork because of the oft-cited "curse of dimensionality''. However, users are usually interested in querying data over a relativelysmall subset of the entire attribute set at a time. A potential solution is to use lower dimensional indexes that accurately represent the user access patterns. Query response using physical database design developed based on a static snapshot of the query workload may significantly degrade if the query patterns change.To address these issues, we introduce a parameterizable technique to recommend indexes based on index types frequently used forhigh-dimensional data sets and to dynamically adjust indexesas the underlying query workload changes. We incorporate aquery pattern change detection mechanism to determine when the access patterns have changed enough to warrant change inthe physical database design. By adjusting analysis parameters,we trade off analysis speed against analysis resolution. We perform experiments with a number of data sets, query sets, and parameters to show the effect that varying these characteristics has on analysis results.
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This study compared postoperative complications of patients who underwent pancreaticoduodenectomy (PD) recorded in the National Surgical Quality Improvement Program (NSQIP) to patients who underwent PD recorded in the Healthcare C...
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This study compared postoperative complications of patients who underwent pancreaticoduodenectomy (PD) recorded in the National Surgical Quality Improvement Program (NSQIP) to patients who underwent PD recorded in the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS).
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The case study describes a small consulting company's experience in the design and implementation of a database and associated information retrieval system. Their choices are explained within the context of the firm's needs and co...
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The case study describes a small consulting company's experience in the design and implementation of a database and associated information retrieval system. Their choices are explained within the context of the firm's needs and constraints. Issues associated with development methods are discussed, along with problems that arose from not following proper development disciplines.
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When delivering digitalization of educational services, a specific administration plan should be established, designed for maximum access, quick recovery from failure, and lowering the length of time it is unavailable, all while g...
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When delivering digitalization of educational services, a specific administration plan should be established, designed for maximum access, quick recovery from failure, and lowering the length of time it is unavailable, all while guaranteeing good security performance. It should include responsibilities such as providing dedicated servers for digitizing educational services, increasing security by using encryption and security-compliant network protocols, and database administration. To speed up the digitization of educational services, it is recommended that all databases be placed on a single server that will serve as the publisher, and that separate databases be distributed to three different servers that will act as the subscribers.
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The purpose of this exploratory study was to determine the critical success factors (CSFs) of data and database administration functions. A field survey was made in 16 large corporations of information systems executives who were ...
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The purpose of this exploratory study was to determine the critical success factors (CSFs) of data and database administration functions. A field survey was made in 16 large corporations of information systems executives who were identified as having a key role and interest in data management issues. Several important data and database administration factors were identified. Of these, three were found to be CSFs for data administration and four were found to be CSFs for database administration. Two overlapped both areas. The overlapping factors had to be considered from both a technical and organizational perspective.
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The use of"big data" in neurosurgical research has become increasingly popular. However, using this type of data comes with limitations. This study aimed to shed light on this new approach to clinical research. We compiled a list ...
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The use of"big data" in neurosurgical research has become increasingly popular. However, using this type of data comes with limitations. This study aimed to shed light on this new approach to clinical research. We compiled a list of commonly used databases that were not specifically created to study neurosurgical procedures, conditions, or diseases. Three North American journalsweremanually searched for articles published since 2000 utilizing these and other non-neurosurgery-specific databases. A number of data points per article were collected, tallied, and analyzed.
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PURPOSE:: The purpose of this article was to discuss common issues associated with large databases and present possible solutions to improve the quality and usefulness of large database research. BACKGROUND:: The volume of electro...
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PURPOSE:: The purpose of this article was to discuss common issues associated with large databases and present possible solutions to improve the quality and usefulness of large database research. BACKGROUND:: The volume of electronic healthcare-related data is growing exponentially. Some of these data are being stored in registries and administrative databases. These data repositories are increasingly common and can serve as sources of nurse-driven research and quality improvement activities. Although these large databases have a wealth of useful information, they have limitations that may bias results. These include missing data and cases, data accuracy and validity, and the statistical effect of large samples. DESCRIPTION:: Researchers using large databases to address quality, safety, clinical, or systems issues have a variety of available techniques to deal with data issues. Proper data cleaning activities such as screening, visualization, and outlier/inlier identification are essential for addressing inaccurate values within large data sets. Common methods for addressing missing data include case analyses and various imputation techniques. Statistical approaches such as risk reductions and effect size are also useful when working with large sample sizes. CONCLUSION/IMPLICATIONS:: Registries and administrative databases provide healthcare researchers with increasing opportunities to address a wide variety of important practice and patient care questions. Healthcare researchers are encouraged to explore large data sets as they look for ways to improve patient safety and quality care, develop evidence-based practice guidelines, and fulfill regulatory and accreditation requirements. ? 2013 Lippincott Williams & Wilkins.
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Outcomes research has established itself as an integral part of surgical research as physicians and hospitals are increasingly required to demonstrate attainment of performance markers and surgical safety indicators. Large-volume ...
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Outcomes research has established itself as an integral part of surgical research as physicians and hospitals are increasingly required to demonstrate attainment of performance markers and surgical safety indicators. Large-volume and clinical and administrative databases are used to study regional practice pattern variations, health care disparities, and resource utilization. Understanding the unique strengths and limitations of these large databases is critical to performing quality surgical outcomes research. In the current work, we review the currently available large-volume databases including selection processes, modes of analyses, data application, and limitations.
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Background: Mental disorders (MDs) in multiple sclerosis (MS) patients decreases treatment adherence and quality of life, and increases the risk of disability progression and care consumption. Objective: This study was to assess t...
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Background: Mental disorders (MDs) in multiple sclerosis (MS) patients decreases treatment adherence and quality of life, and increases the risk of disability progression and care consumption. Objective: This study was to assess the prevalence of MDs in MS patients compared with healthy controls (HC) of the French general population and rheumatoid arthritis (RA) patients. Methods: The 2015 prevalence of MDs for MS patients, RA patients and general population was estimated using a random population-based data sample from ‘National Inter-Scheme Information System on Health Insurance’ in the 2011–2015 period. Two control groups (1:5 ratio for the HC and 1:1 for the RA group) were matched to the MS group for year of birth, gender, area of residence and health insurance scheme. Results: A total of 1145 MS patients were identified (sex ratio of 2.5 (F/M); median age 50 years). The prevalence of MDs was higher in the population of patients with MS (37.3%) than in the French general population (13.6%), and to a lesser extent in the RA group (21.1%) leading to the prevalence ratios of 2.8 (95% confidence intervals (CIs) 2.5–3.0) and 1.9 (95% CI 1.7–2.3), respectively. Conclusions: This study confirmed that MS patients are at a higher risk of MDs than the French general population or RA patients.
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