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The aim of this study initiated in May 1990 was to evaluate the quality of the medical data collected from the main hospital of the "Hospices Civils de Lyon", Edouard Herriot Hospital. We studied a random sample of 593 discharge abstracts from 12 wards of the hospital. Quality control was performed by checking multi-hospitalized patients' personal data, checking that each discharge abstract was exhaustive, examining the quality of abstracting, studying diagnoses and medical procedures coding, and checking data entry. Assessment of personal data showed a 4.4% error rate. It was mainly accounted for by spelling mistakes in surnames and first names, and mistakes in dates of birth. The quality of a discharge abstract was estimated according to the two purposes of the medical information system: description of hospital morbidity per patient and Diagnosis Related Group's case mix. Error rates in discharge abstracts were expressed in two ways: an overall rate for errors of concordance between Discharge Abstracts and Medical Records, and a specific rate for errors modifying classification in Diagnosis Related Groups (DRG). For abstracting medical information, these error rates were 11.5% (SE +/- 2.2) and 7.5% (SE +/- 1.9) respectively. For coding diagnoses and procedures, they were 11.4% (SE +/- 1.5) and 1.3% (SE +/- 0.5) respectively. For data entry on the computerized data base, the error rate was 2% (SE +/- 0.5) and 0.2% (SE +/- 0.05). Quality control must be performed regularly because it demonstrates the degree of participation from health care teams and the coherence of the database.(ABSTRACT TRUNCATED AT 250 WORDS)

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Meta-analysis corresponds to all systematic methods which use statistical techniques for combining results from several independent studies. The aim is to get a consistent estimation of the global effect of a procedure on a specified outcome. The technique allows us to increase the power of statistical testing, and to get information which cannot be drawn from one individual study. Two approaches are possible, and often combined: the qualitative approach consists of weighing various studies according to their methodological quality; the quantitative approach consists of pooling the results of different studies, in order to generate results with a higher statistical power. A meta-analysis is a long and rigorous process, which follows several steps: statement of objectives; definition of articles inclusion and exclusion criteria; literature search; collection of data and evaluation of the quality of each study; tests for homogeneity; pooling; sensitivity analyses; presentation of results; and conclusions. Meta-analysis has several advantages: it estimates the size of an effect; it improves the generalizability; it compels to rigor; it lessens the part of subjectivity. When meta-analysis is cautiously and properly done, it brings new useful information, and helps physicians and health policy makers in answering to a specific question.

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The aim of the study was to evaluate the virological parameters associated with the severity of cytomegalovirus (CMV) disease in renal and simultaneous renal and pancreatic transplantation. The association of the viral profile and the severity of the viral disease was analysed taking into account different confounding variables susceptible to linkage with the severity of the CMV infection and the viral parameters. All the patients transplanted between 1 January 1989 and31 December 1990, a total of 242, were prospectively followed by viral cultures in blood and urine and by serological methods using the detection of CMV-specific IgM and the complement fixation (CF) test. The samples were taken systematically each week for the first month and then at day 90, 180 and every 6 months and also in cases of clinical manifestations related to viral disease. CMV infection was diagnosed virologically by the presence of viraemia, viruria, lgM, or a significant rise in CMV antibody titre in CF. CMV disease was classified as asymptomatic, mild (fever and/or leukopenia), moderate (fever, leukopenia and liver abnormalities), severe (CMV pneumopathy and/or gastrointestinal disease) or fatal. The incidence of CMV infection was 65% (157 /242): 32% asymptomatic, 36% mild, 30% moderate and 2% severe. The presence of JgM was associated with the severity of CMV disease: 51.4% of moderate and severe CMV infections in the group with IgM versus only 16% in the group without lgM (P < 0.0001). The risk of having severe or moderate CMV disease was 3.28 times higher in patients with positive JgM. However the serological changes in CF were not significantly associated with the severity of the viral disease since 34.6% of the patients with CF changes had a severe form versus 20.8% in the group without CF modification. Viruria was significantly associated with moderate or severe infection: 43.6% of the patients with viruria had severe infection versus only 12.5% in the patients without viruria