Quality of life and survival in patients treated with radical chemoradiation alone for oesophageal cancer

Aims: To report cancer-specific and health-related quality-of-life outcomes in patients undergoing radical chemoradiation (CRT) alone for oesophageal cancer. Materials and methods: Between 1998 and 2005, 56 patients with oesophageal cancer received definitive radical CRT, due to local disease extent, poor general health, or patient choice. Data from European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-30 and QLQ-OES24 were collected prospectively. Questionnaires were completed at diagnosis, and at 3, 6 and 12 months after CRT where applicable. Results: The median follow-up was 18 months. The median overall survival was 14 months, with a 51, 26 and 13% 1-, 3- and 5-year survival, respectively. At 12 months after treatment there was a significant improvement compared with before treatment with respect to dysphagia and pain. Global health scores were not significantly affected. Conclusions: Considering the relatively short long-term survival for this cohort of patients, maximising the quality of those final months should be very carefully borne in mind from the outset. The health-related quality-of-life data reported herein helps to establish benchmarks for larger evaluation within randomised clinical trials. © 2007 The Royal College of Radiologists.

Quality of child abuse information for measurement and surveillance : linking hospital and child welfare data

National estimates of the prevalence of child abuse-related injuries are obtained from a variety of sectors including welfare, justice, and health resulting in inconsistent estimates across sectors. The International Classification of Diseases (ICD) is used as the international standard for categorising health data and aggregating data for statistical purposes, though there has been limited validation of the quality, completeness or concordance of these data with other sectors. This research study examined the quality of documentation and coding of child abuse recorded in hospital records in Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of over 1000 hospitalised injured children from 20 hospitals in Queensland. A data linkage methodology was used to link these records with records in the child welfare database. Cases were sampled from three sub-groups according to the presence of target ICD codes: Definite abuse, Possible abuse, unintentional injury. Less than 2% of cases coded as being unintentional were recoded after review as being possible abuse, and only 5% of cases coded as possible abuse cases were reclassified as unintentional, though there was greater variation in the classification of cases as definite abuse compared to possible abuse. Concordance of health data with child welfare data varied across patient subgroups. This study will inform the development of strategies to improve the quality, consistency and concordance of information between health and welfare agencies to ensure adequate system responses to children at risk of abuse.

Quality of child abuse information in emergency department injury surveillance data : linking hospital and child welfare data

Emergency departments (EDs) are often the first point of contact with an abused child. Despite legal mandate, the reporting of definite or suspected abusive injury to child safety authorities by ED clinicians varies due to a number of factors including training, access to child safety professionals, departmental culture and a fear of ‘getting it wrong’. This study examined the quality of documentation and coding of child abuse captured by ED based injury surveillance data and ED medical records in the state of Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of almost 1000 injured children included in the Queensland Injury Surveillance Unit database (QISU) from 10 hospitals in urban and rural centres. Independent experts re-coded the records based on their review of the notes. A data linkage methodology was then used to link these records with records in the state government’s child welfare database. Cases were sampled from three sub-groups according to the surveillance intent codes: Maltreatment by parent, Undetermined and Unintentional injury. Only 0.1% of cases coded as unintentional injury were recoded to maltreatment by parent, while 1.2% of cases coded as maltreatment by parent were reclassified as unintentional and 5% of cases where the intent was undetermined by the triage nurse were recoded as maltreatment by parent. Quality of documentation varied across type of hospital (tertiary referral centre, children’s, urban, regional and remote). Concordance of health data with child welfare data varied across patient subgroups. Outcomes from this research will guide initiatives to improve the quality of intentional child injury surveillance systems.

Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3%) of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost). A further 119 (49%) could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status). Another 88 (36%) required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases) and 28 (11.5%) required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

Perceptions of data quality dimensions and data roles

Several authors stress the importance of data’s crucial foundation for operational, tactical and strategic decisions (e.g., Redman 1998, Tee et al. 2007). Data provides the basis for decision making as data collection and processing is typically associated with reducing uncertainty in order to make more effective decisions (Daft and Lengel 1986). While the first series of investments of Information Systems/Information Technology (IS/IT) into organizations improved data collection, restricted computational capacity and limited processing power created challenges (Simon 1960). Fifty years on, capacity and processing problems are increasingly less relevant; in fact, the opposite exists. Determining data relevance and usefulness is complicated by increased data capture and storage capacity, as well as continual improvements in information processing capability. As the IT landscape changes, businesses are inundated with ever-increasing volumes of data from both internal and external sources available on both an ad-hoc and real-time basis. More data, however, does not necessarily translate into more effective and efficient organizations, nor does it increase the likelihood of better or timelier decisions. This raises questions about what data managers require to assist their decision making processes.

Priorities for developing and evaluating data quality characteristics of road crash data in Australia

The National Road Safety Strategy 2011-2020 outlines plans to reduce the burden of road trauma via improvements and interventions relating to safe roads, safe speeds, safe vehicles, and safe people. It also highlights that a key aspect in achieving these goals is the availability of comprehensive data on the issue. The use of data is essential so that more in-depth epidemiologic studies of risk can be conducted as well as to allow effective evaluation of road safety interventions and programs. Before utilising data to evaluate the efficacy of prevention programs it is important for a systematic evaluation of the quality of underlying data sources to be undertaken to ensure any trends which are identified reflect true estimates rather than spurious data effects. However, there has been little scientific work specifically focused on establishing core data quality characteristics pertinent to the road safety field and limited work undertaken to develop methods for evaluating data sources according to these core characteristics. There are a variety of data sources in which traffic-related incidents and resulting injuries are recorded, which are collected for a variety of defined purposes. These include police reports, transport safety databases, emergency department data, hospital morbidity data and mortality data to name a few. However, as these data are collected for specific purposes, each of these data sources suffers from some limitations when seeking to gain a complete picture of the problem. Limitations of current data sources include: delays in data being available, lack of accurate and/or specific location information, and an underreporting of crashes involving particular road user groups such as cyclists. This paper proposes core data quality characteristics that could be used to systematically assess road crash data sources to provide a standardised approach for evaluating data quality in the road safety field. The potential for data linkage to qualitatively and quantitatively improve the quality and comprehensiveness of road crash data is also discussed.

A data mining approach to improve the automated quality of data

This thesis describes the development of a robust and novel prototype to address the data quality problems that relate to the dimension of outlier data. It thoroughly investigates the associated problems with regards to detecting, assessing and determining the severity of the problem of outlier data; and proposes granule-mining based alternative techniques to significantly improve the effectiveness of mining and assessing outlier data.

Visual metrics for the evaluation of sensor data quality in outdoor perception

This paper proposes an experimental study of quality metrics that can be applied to visual and infrared images acquired from cameras onboard an unmanned ground vehicle (UGV). The relevance of existing metrics in this context is discussed and a novel metric is introduced. Selected metrics are evaluated on data collected by a UGV in clear and challenging environmental conditions, represented in this paper by the presence of airborne dust or smoke. An example of application is given with monocular SLAM estimating the pose of the UGV while smoke is present in the environment. It is shown that the proposed novel quality metric can be used to anticipate situations where the quality of the pose estimate will be significantly degraded due to the input image data. This leads to decisions of advantageously switching between data sources (e.g. using infrared images instead of visual images).

Visual metrics for the evaluation of sensor data quality in outdoor perception

This paper proposes an experimental study of quality metrics that can be applied to visual and infrared images acquired from cameras onboard an unmanned ground vehicle (UGV). The relevance of existing metrics in this context is discussed and a novel metric is introduced. Selected metrics are evaluated on data collected by a UGV in clear and challenging environmental conditions, represented in this paper by the presence of airborne dust or smoke.

Health Information Exchange in the wake of ‘big data’ paradigm – the theme is from ‘quality of information to quality of life’

Health Information Exchange (HIE) is an interesting phenomenon. It is a patient centric health and/or medical information management scenario enhanced by integration of Information and Communication Technologies (ICT). While health information systems are repositioning complex system directives, in the wake of the ‘big data’ paradigm, extracting quality information is challenging. It is anticipated that in this talk, ICT enabled healthcare scenarios with big data analytics will be shared. In addition, research and development regarding big data analytics, such as current trends of using these technologies for health care services and critical research challenges when extracting quality of information to improve quality of life will be discussed.

Piecing the puzzle together : enhancing the quality of road trauma surveillance through linkage of police and health data

This program of research linked police and health data collections to investigate the potential benefits for road safety in terms of enhancing the quality of data. This research has important implications for road safety because, although police collected data has historically underpinned efforts in the area, it is known that many road crashes are not reported to police and that these data lack specific injury severity information. This research shows that data linkage provides a more accurate quantification of the severity and prevalence of road crash injuries which is essential for: prioritising funding; targeting interventions; and estimating the burden and cost of road trauma.

Quality of information for quality of life: Healthcare big data analytics

Big data analysis in healthcare sector is still in its early stages when comparing with that of other business sectors due to numerous reasons. Accommodating the volume, velocity and variety of healthcare data Identifying platforms that examine data from multiple sources, such as clinical records, genomic data, financial systems, and administrative systems Electronic Health Record (EHR) is a key information resource for big data analysis and is also composed of varied co-created values. Successful integration and crossing of different subfields of healthcare data such as biomedical informatics and health informatics could lead to huge improvement for the end users of the health care system, i.e. the patients.

Measuring the quality of teaching in elementary school classrooms

This paper reviews the means by which teacher quality has been measured. It considers data sources such as students, peers, experts, and examines the psychometrics and scaleproperties of teacher quality assessment instruments with respect to reliability and validity. A list of items for possible inclusion in an elementary student focussed instrument is considered, together with the potential use of such an instrument in measuring teacher quality.

The relationship between clinical outcomes and quality of life for residents of aged care facilities

Objectives It is widely assumed improving care in residential facilities will improve quality of life (QoL), but little research has explored this relationship. The Clinical Care Indicators (CCI) Tool was developed to fill an existing gap in quality assessment within Australian residential aged care facilities and it was used to explore potential links between clinical outcomes and QoL. Design and Setting Clinical outcome and QoL data were collected within four residential facilities from the same aged care provider. Subjects Subjects were 82 residents of four facilities. Outcome Measures Clinical outcomes were measured using the CCI Tool and QoL data was obtained using the Australian WHOQOL‑100. Results Independent t‑test analyses were calculated to compare individual CCIs with each domain of the WHOQOL‑100, while Pearson’s product moment coefficients (r) were calculated between the total number of problem indicators and QoL scores. Significant results suggested poorer clinical outcomes adversely affected QoL. Social and spiritual QoL were particularly affected by clinical outcomes and poorer status in hydration, falls and depression were most strongly associated with lower QoL scores. Poorer clinical status as a whole was also significantly correlated with poorer QoL. Conclusions Hydration, falls and depression were most often associated with poorer resident QoL and as such appear to be key areas for clinical management in residential aged care. However, poor clinical outcomes overall also adversely affected QoL, which suggests maintaining optimum clinical status through high quality nursing care, would not only be important for resident health but also for enhancing general life quality.

Health-related quality of life in obese children and adolescents

Objective: This review addresses the effect of overweight and obese weight status on pediatric health-related quality of life (HRQOL). Method: Web of Science, Medline, CINAHL, Cochrane Library, EMBASE, AMED and PubMed were searched for peer-reviewed studies in English reporting HRQOL and weight status in youth (<21 years), published before March 2008. Results: Twenty-eight articles were identified. Regression of HRQOL against body mass index (BMI) using pooled data from 13 studies utilizing the Pediatric Quality of Life Inventory identified an inverse relationship between BMI and pediatric HRQOL (r=−0.7, P=0.008), with impairments in physical and social functioning consistently reported. HRQOL seemed to improve with weight loss, but randomized controlled trials were few and lacked long-term follow-up. Conclusions: Little is known about the factors associated with reduced HRQOL among overweight or obese youth, although gender, age and obesity-related co-morbidities may play a role. Few studies have examined the differences in HRQOL between community and treatment-seeking samples. Pooled regressions suggest pediatric self-reported HRQOL can be predicted from parent proxy reports, although parents of obese youths tend to perceive worse HRQOL than children do about themselves. Thus, future research should include both pediatric and parent proxy perspectives.