RESUMEN
We compared two methods of ascertaining mortality in a historical prospective mortality study. Computerized Record Linkage (CRL) with the centralized historical Canadian Mortality Data Base (CMDB) was carried out on 2469 men and an attempt was also made to trace the subjects by individual follow-up (IFU). All but 88 were traced and 60 were reported to be dead. CRL was able to locate the deaths of three men who had been untraced by IFU. Contradictory information on vital status was obtained on 5 subjects--in 4 of them, the discrepancy was resolved in favour of CRL. Overall, CRL using the CMDB performed very well. We also consider factors that affect the relative costs of the two methods, which should be balanced against the accuracy of information obtained.
Asunto(s)
Registro Médico Coordinado , Registros Médicos , Mortalidad/estadística & datos numéricos , Canadá , Recolección de Datos/normas , Estudios de Seguimiento/métodos , Sistemas de Información , Ontario , Estudios Prospectivos/métodosRESUMEN
In recent years, reproductive disorders in athletes have been observed in increasing numbers and proportions as larger numbers of women are participating in more strenuous athletic activities. Clinical problems with infertility and decreased bone density have been reported in this group, which has prided itself on its health. Hypoestrogenic women, including amenorrheic athletes, should definitely seek medical treatment for the prevention of osteoporosis, but before women sacrifice the many benefits of strenuous exercise, it is appropriate to consider the strength of the evidence that exercise training in particular, rather than other, extraneous aspects of athletic training, is responsible for the hormonal changes associated with reproductive disorders. This review has examined this first link in the postulated causal chain between exercise and these clinical conditions. In this review, only those studies that have compared trained or highly trained women with untrained or less-trained women, either cross-sectionally or longitudinally have been considered. In assessing the credibility of the reported results, we have found that the extensive precautions, painstaking techniques, and powerful protocols required for studying the question have only slowly been appreciated and never fully implemented by investigators. As a result, most of the published results are of little value. The few studies less susceptible to such criticism are consistent in their observations of gonadotropin and ovarian steroid suppression in women participating in athletic training. Nevertheless, even these results may have been biased by confounding factors, and thus at the present time the first link in the causal chain of events from exercise training to infertility and fractures cannot be regarded as proven. If the observed suppression of reproductive hormones is, indeed, due to exercise training, it may be dependent upon either the intensity of exercise training or the rate at which the intensity is increased. A dependence upon the rate at which exercise intensity is increased may explain why large proportions of athletes at all exercise intensity levels remain eumenorrheic. If future studies eliminate the biasing effects of known confounding factors and confirm that the female reproductive system can be suppressed by exercise training in particular, then additional research will be needed to determine the training intensity or rate of change in intensity required for these effects to occur. Research will also be needed to determine how gynecologic age, body composition, diet, and psychologic status may exaggerate or attenuate these effects.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Hormonas Esteroides Gonadales/fisiología , Educación y Entrenamiento Físico , Estudios Transversales/métodos , Femenino , Fracturas Óseas/etiología , Humanos , Infertilidad/etiología , Menarquia , Ciclo Menstrual , Métodos , Estudios Prospectivos/métodos , Distribución Aleatoria , Reproducción , Proyectos de InvestigaciónRESUMEN
We describe a medical information system tailored to the operational needs of the Gynecologic and Infertility Clinic at The Johns Hopkins Hospital. It is used for patient registration and scheduling, medical and surgical record keeping, and research investigation. Data entered include a complete medical history, diagnoses, procedures performed and their outcomes, surgical pathologic study, follow-up notes, phone consultations, and laboratory findings. Data are coded individually and can be retrieved and presented in a standard or user-specific report format. The Reproductive Endocrinology Medical Information System (REMIS) was implemented over 6 months from January to June 1984. To date, 8000 new patient registrations and 3600 outpatient visits have been entered. There are approximately 100 new patient entries and 240 return visit entries per month. Preliminary evaluation of the system based on the effect on quality care, use by each user group, and research applicability demonstrates that the REMIS provides clinicians with more complete, organized, and accessible patient records to serve as an effective adjunct to clinical operations.
Asunto(s)
Endocrinología , Sistemas en Línea , Servicio Ambulatorio en Hospital/organización & administración , Reproducción , Citas y Horarios , Computadores , Femenino , Hospitales con más de 500 Camas , Humanos , Infertilidad Femenina/terapia , Maryland , Registros Médicos , Estudios Prospectivos/métodos , Proyectos de Investigación , Estudios Retrospectivos/métodos , Programas InformáticosRESUMEN
Prospective controlled studies give the most reliable background for clinical decisions. To use them correctly, however, many strict premises have to be fulfilled that are often impossible in practice. If no research is conducted in these cases, however, that means disastrous dependence on one method. The main application of retrospective analyses is therefore in the sense of a second-best solution. Furthermore, retrospective consideration is a genuine necessity for medical research if you are interested in the critical reflection of your own work and in dealing with new problems.
Asunto(s)
Estudios Prospectivos/métodos , Estudios Retrospectivos/métodos , Humanos , Distribución Aleatoria , Procedimientos Quirúrgicos OperativosAsunto(s)
Antihipertensivos/uso terapéutico , Evaluación de Medicamentos/métodos , Hipertensión/tratamiento farmacológico , Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Estudios de Seguimiento/métodos , Hemodinámica/efectos de los fármacos , Humanos , Riñón/efectos de los fármacos , Metabolismo/efectos de los fármacos , Estudios Prospectivos/métodosRESUMEN
A prospective study of 102 patients with chronic lymphocytic leukaemia (CLL) on 30 parameters subdivided into 77 variables was analyzed by correspondence analysis, a variant of principal component analysis, which allows simultaneous graphical representation of patients and variables. This statistical method clearly defined three principal clinical features recognized at the time of diagnosis: lymph node proliferation, lymphoid infiltration and cytopenia. Cytopenia was clearly subdivided into peripheral and central types. Each of these clinical features were derived from clinical and laboratory observations which agreed with each other. Simple examination permitted an evaluation of these three syndromes. They seemed to be independent of each other except for a relationship between central cytopenia and lymphoid infiltration. Thus clinical staging at the moment of diagnosis must record three scales of severity corresponding to the three independant clinical features. Prognosis was essentially related to cytopenia, whatever the mechanism. In a further analysis of the subsequent progress of the disease, a "common path" for patients was found terminating in a region of the graph where marked splenomegaly and cytopenia were plotted. We conclude that it is necessary to consider the three clinical features independently in a clinical staging. This study emphasizes the poor prognosis of cytopenia and splenomegaly and indicates that follow up and treatment should take this feature into account.