This is the first national Veterans Health Administration hip fracture hospitalisation study that temporally linked outpatient fall-related medications in hip-fracture patients with matched controls. We found that of veterans with hip-fracture hospitalisations, 70% were prescribed outpatient medications from selected major drug categories that may potentially increase fall risk. Moreover, over one-third of hip-fracture patients received concomitant prescriptions of drugs from multiple selected drug categories. Hip-fracture patients, compared with matched controls of acute MI and pneumonia, had the largest pronounced differences in prescribed medications in the antiepileptics, antidepressants, antipsychotics and antiparkinson's drug classes. Although a randomised clinical trial is the 'gold standard' for determining causation issues, exposing patients, particularly the elderly, to the potential risk of injurious falls would raise serious patient safety research approval issues. If the relationship between selected drugs and falls is indeed to some extent causative, future retrospective multivariate analyses could quantify the magnitude of these effects.

Objective:To determine the effectiveness of 8-week group functional balance training classes on balance outcomes in community-dwelling veterans at risk for falls.Design:Pre-test, post-test using retrospective data.Setting:VISN 8 Patient Safety Center at James A. Haley Veterans Hospital in Tampa, FL, USA.Participants:Fifty one community living veterans with mean age of 78 at risk for falls.Intervention:Participants received a weekly 1-hour functional balance training class for 8 weeks in a small group setting (4–5 participants).Measurements:Pre and post intervention measures included Berg Balance Scale, Limits of Stability (LOS) and modified Clinical Test of Sensory Interaction on Balance (mCTSIB).Results:Eighty four percent of the participants completed 5 or more weekly classes. Peripheral neuropathy was the most common risk factor among the participants. There was a significant improvement in the Berg (p < 0.0001) and Composite Reaction Time (p < 0.0004) after the intervention.Conclusion:An eight week group functional balance training class was safe and effective in improving balance outcomes in a cohort of elderly veterans at risk for falls.

IN BRIEF The accurate measurement of glucose is extremely important in the diagnosis of diabetes and pre-diabetes, where the laboratory values are crucial; in the management of diabetes, where glucose meter values are crucial; and in attainment of goals in diabetes, where hemoglobin A1c measurement is crucial. This article reviews pitfalls that may interfere with accuracy of glucose measurement in each of these three areas and how this inaccuracy may be evaluated and managed in the primary care setting. Three case presentations of disparity are discussed.

Unintentional injury due to falls is a serious and expensive health problem among the elderly. This is especially true in the Veterans Health Administration (VHA) ambulatory care setting, where nearly 40% of the male patients are 65 or older and at risk for falls. Health service researchers and clinicians can utilize VHA administrative data to identify and explore the frequency and nature of fallrelated injuries (FRI) to aid in the implementation of clinical and prevention programs. Here we define administrative data as structured (coded) values that are generated as a result clinical services provided to veterans and stored in databases. However, the limitations of administrative data do not always allow for conclusive decision making, especially in areas where coding may be incomplete. This study utilizes data and text mining techniques to investigate if unstructured text-based information included in the electronic medical record can validate and enhance those records in the administrative data that should have been coded as fallrelated injuries. The challenges highlighted by this study include data extraction and preparation from administrative sources and the full electronic medical records, de-indentifying the data (to assure HIPAA compliance), conducting chart reviews to construct a ''gold standard'' dataset, and performing both supervised and unsupervised text mining techniques in comparison with traditional medical chart review.

OBJECTIVESeveral studies have suggested that HbA1c levels may predict incident diabetes. With new recommendations for use of HbA1c in diagnosing diabetes, many patients with HbA1c results below the diagnostic threshold will be identified. Clinicians will need to categorize risk for a subsequent diabetic diagnosis in such patients. The objective of this study was to determine the ability of HbA1c to predict the incidence of a diabetic diagnosis.RESEARCH DESIGN AND METHODSWe performed a historical cohort study using electronic medical record data from two Department of Veterans Affairs Medical Centers. Patients (n = 12,589) were identified with a baseline HbA1c <6.5% between January 2000 and December 2001 and without a diagnosis of diabetes. Patients (12,375) had at least one subsequent follow-up visit. These patients were tracked for 8 years for a subsequent diagnosis of diabetes.RESULTSDuring an average follow-up of 4.4 years, 3,329 (26.9%) developed diabetes. HbA1c ≥5.0% carried a significant risk for developing diabetes during follow-up. When compared with the reference group (HbA1c <4.5%), HbA1c increments of 0.5% between 5.0 and 6.4% had adjusted odds ratios of 1.70 (5.0–5.4%), 4.87 (5.5–5.9%), and 16.06 (6.0–6.4%) (P < 0.0001). Estimates of hazard ratios similarly showed significant increases for HbA1c ≥5.0%. A risk model for incident diabetes within 5 years was developed and validated using HbA1c, age, BMI, and systolic blood pressure.CONCLUSIONSThe incidence of diabetes progressively and significantly increased among patients with an HbA1c ≥5.0%, with substantially expanded risk for those with HbA1c 6.0–6.4%.

This study was conducted to assess and benchmark the quality of care,

Context.-The College of American Pathologists has been producing cancer protocols since 1986 to aid pathologists in the diagnosis and reporting of cancer cases. Many pathologists use the included cancer case summaries as templates for dictation/data entry into the final pathology report. These summaries are now available in a computer-readable format with structured data elements for interoperability, packaged as ''electronic cancer checklists.'' Most major vendors of anatomic pathology reporting software support this model.Objectives.-To outline the development and advantages of structured electronic cancer reporting using the electronic cancer checklist model, and to describe its extension to cancer biomarkers and other aspects of cancer reporting.Data Sources.-Peer-reviewed literature and internal records of the College of American Pathologists.Conclusions.-Accurate and usable cancer biomarker data reporting will increasingly depend on initial capture of this information as structured data. This process will support the standardization of data elements and biomarker terminology, enabling the meaningful use of these datasets by pathologists, clinicians, tumor registries, and patients.

Thromboembolic (TE) events preceding cancer have been observed. Some studies failed to find this correlation. We retrospectively examined the cancer incidence following thromboembolic events in patients at our medical center. Medical records of 183 patients with established thromboembolic events documented in their records were selected and reviewed. Time interval between primary, secondary, and recurrent TE events preceding cancer diagnosis was analyzed. Two hundred age-and sex-matched controls seen during the same period and without any evidence of TE were randomly selected and charts reviewed for malignancy. Cancer occurred after TE in 48 of 183 patients (26.2%). In controls, cancer was diagnosed in 23 (11.5%). This was statistically significant with an odds ratio of 2.736 (1.586, 4.720). In the 64 primary TE patients, the cancer incidence was 37.5%. The 63 patients with recurrent TE had an incidence of 35.4%, and 56 secondary TE patients had an incidence of 27.1%. Time between initial TE and cancer diagnosis was <6 months in 27 (56.3%) patients, between 6 months and 1 year in 12 (25.0%), 1-5 years in 5 (10.4%), and >5 years in 4 (8.3%). Fourteen (31.1%) TE patients presented with metastatic cancer. This study indicates that thromboembolic events are important predictors of cancer. Cancer in this population occurs within a year in the majority of patients. Cancer screening in patients without identifiable risk factors for thrombosis could be helpful for early detection, diagnosis, and management of cancer. Am. J. Hematol. 72: 109-114, 2003.