ObjectivesElectronic physician claims databases are widely used for chronic disease research and surveillance, but quality of the data may vary with a number of physician characteristics, including payment method. The objectives were to develop a prediction model for the number of prevalent diabetes cases in fee-for-service (FFS) electronic physician claims databases and apply it to estimate cases among non-FFS (NFFS) physicians, for whom claims data are often incomplete.DesignA retrospective observational cohort design was adopted.SettingData from the Canadian province of Newfoundland and Labrador were used to construct the prediction model and data from the province of Manitoba were used to externally validate the model.ParticipantsA cohort of diagnosed diabetes cases was ascertained from physician claims, insured resident registry and hospitalisation records. A cohort of FFS physicians who were responsible for the diagnosis was ascertained from physician claims and registry data.Primary and secondary outcome measuresA generalised linear model with a γ distribution was used to model the number of diabetes cases per FFS physician as a function of physician characteristics. The expected number of diabetes cases per NFFS physician was estimated.ResultsThe diabetes case cohort consisted of 31 714 individuals; the mean cases per FFS physician was 75.5 (median=49.0). Sex and years since specialty licensure were significantly associated (p<0.05) with the number of cases per physician. Applying the prediction model to NFFS physician registry data resulted in an estimate of 18 546 cases; only 411 were observed in claims data. The model demonstrated face validity in an independent data set.ConclusionsComparing observed and predicted disease cases is a useful and generalisable approach to assess the quality of electronic databases for population-based research and surveillance.
characteristics are listed in the Table . A total of 53% presented with tissue loss. There were 119 of 400 (29%) who had SFA access, with technical success achieved in 115 (96.6%). There were no statistically significant differences in technical success (96.6% vs 93.1%; P ¼ .399), distal embolization (0% vs 0.3%; P ¼ .513), arterial perforation (0% vs 0.7%; P ¼ .525), dissection (0% vs 0.7%; P ¼ .620), and hematoma (0.8% vs 0.7%; P ¼ .3) between SFA and retrograde access, respectively. All patients were discharged to preprocedure dwelling. One SFA access patient presented with delayed bleeding requiring operative repair, prolonged hospitalization, and subsequent death. There were no access site occlusions in either group.Conclusions: Direct antegrade puncture of the SFA is a safe and effective technique of arterial access for treatment of distal SFA and infrapopliteal disease in an office-based setting.
The term "Quality management" has a specific meaning within many business sectors. Quality has metamorphosed from the synonyms of "Customer satisfaction" to "Customer delight", thriving for excellence in every sphere of business with continuous improvements. In today's business scenario, more often quality is perceived as "Fitness for purpose "focusing on the customer. But there is horizon beyond this as, "quality" is always intertwined with "safety and reliability" if the nature of the business is perilous. The prime focus for any nuclear industry is about the safety and reliability which can be accomplished only through the inherent quality. The quality embarks right from the construction phase of the nuclear power plant till the decommissioning and the four main components i.e. quality planning, quality control, quality assurance and quality improvement trek alongside. The high temperature low pressure system of fast breeder reactors using sodium as the coolant demands very high reliability and high degree of quality during each and every stage of construction of all the individual components for trouble free operation of the reactor for the committed years. The "Quality Assurance (QA)" plan of Prototype Fast Breeder Reactor is unique. The reactor being first of its kind in India, quality assurance starts right from the raw material procurement and extends through all the stages of plant till commissioning. The principal material of construction being stainless steel for the reactor components shall be handled with care following best engineering practices coupled with stringent QA requirements to avoid stress corrosion cracking in the highly brackish environment. Integranular stress corrosion cracking and hot cracking are additional factors to be addressed for the welding of stainless steel components. The low alloy ferritic steel like 9Cr-1Mo (mod) has been extensively deployed and the fabrication requires structured inspection, testing and QA plan. Corrosion protection and preservation during fabrication, erection and post erection is mandatory be it reinforcement bar or a reactor vessel.
technique also visualized important features of peripheral arterial lesions that could not be seen with X-ray angiography (the current "gold standard"). Future work will determine whether MRI characterization of lesions can predict long-term endovascular outcomes and aid in procedure planning.
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