1985 excludes January-September for this file type, due to insufficient identifying information on the LCF.

INTRODUCTION: Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS: Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS: DAP patients were younger ( P < 0.0001), had fewer comorbidities ( P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76–0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92–1.00]). A longer time until treatment was associated with better overall survival. CONCLUSION: DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.

An increased risk of intracerebral hemorrhage among heavy consumers of alcohol has been demonstrated in several epidemiologic studies. The effect of moderate or intermediate intakes is, however, unclear. Although several studies provide evidence for a protective effect, this conclusion may be spurious, resulting from the inclusion, within the zero intake (reference) group, of past drinkers who have recently abstained for health reasons. The present study describes the relation between alcohol consumption and intracerebral hemorrhage among 331 case-control pairs recruited in Melbourne, Australia. Heavy drinking was associated with an increased risk of intracerebral hemorrhage (odds ratio (OR) 3.4, 95% confidence interval (CI) = 1.4-8.4). The odds ratio of intracerebral hemorrhage with moderate drinking, when compared with never drinkers, was 0.7, (95% CI = 0.4-1.2) and was 0.6 (95% CI = 0.4-1.0) when compared with nondrinkers (never drinkers plus past drinkers). Wine drinkers were apparently protected from intracerebral hemorrhage (OR 0.5, 95% CI = 0.2-0.9). These results are consistent with the possibility that moderate drinking may confer protection from intracerebral hemorrhage, but this protection may be less than that previously reported.

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The effective and efficient delivery of cervical screening programs requires information for planning, management, delivery and evaluation. Specially designed systems are generally required to meet these needs. In many developing countries, lack of information systems constitutes an important barrier to development of comprehensive screening programs and the effective control of cervical cancer. Our report outlines a framework for creating such systems in developing countries and describes a conceptual model for a cervical screening information system. The proposed system is modular, recognizing that there will be considerable between-region heterogeneity in current status and priorities. The proposed system is centered on modules that would allow for the assembly and computerization of data on Pap tests, since these represent the main screening modality at the present time. Additional modules would process data and create and maintain a screening database (e.g., standardize, edit, link and update modules) and allow for the integration of other types of data, such as cervical histopathology results. An open systems development model is proposed, since it is most compatible with the goals of local stakeholder involvement and capacity-building. © 2002 Wiley-Liss, Inc. Key words: cervical screening; organized screening; information systemsThe effective and efficient delivery of cervical screening programs requires information for program planning, management, delivery and evaluation. In most settings, special information systems are required to meet these needs. Ideally, organized screening programs should have information systems that cover all aspects of screening and follow-up. However, in many situations, information systems that cover some program aspects already exist; for example, some programs are built around laboratory information systems. [1][2][3][4] In these settings, the program system must often be built to be compatible, as much as possible, with existing systems. Regardless, without an effective information system, it is not possible to run an organized cancer screening program, nor is it possible to evaluate whether it is operating as expected or achieving program objectives. Information systems are often considered stand-alone but must be integrated into existing health care information systems.Two important documents describe ideal information system goals and components. 5,6 However, few developing countries have been able to put such systems in place, despite recognizing the need for organized screening. Population registers are essential to the ideal system as envisaged by Miller 6 and others. 7 Successful cervical cancer screening programs (as measured by the rate of decline in cervical cancer incidence and mortality) supported by such systems have existed for some time in the Nordic countries, where population registers are integral to the countries' administrations. 8,9 More recently, impressive declines in cervical cancer mortality have been demonstrated in Australia (from a rate of 4.8 p...