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1
Moore, Marna. "Usage analysis of dermatological products according to a medicine claims database / Marna Moore." Thesis, North-West University, 2006. http://hdl.handle.net/10394/1026.
Full textAbstract:
A large number of people all over the world suffer from skin conditions. Dermatological
problems comprise about 10 % of a general practitioner's caseload and probably more for
pharmacists. The literature furthermore emphasises that skin diseases are becoming a significant
problem in the developing world. There is a need to establish an effective method to achieve
good health and quality of life for patients with dermatological problems.
The general objective of this study was to investigate the usage patterns and cost of
dermatological products in the private health care sector of South Africa by using a medicine
claims database. The focus was specifically on dermatological products with a prevalence of
more than 10 % in the database.
A quantitative retrospective drug utilisation research design was used to evaluate the usage
patterns and costs of dermatological products in three four-monthly intervals of 2001 and 2004.
Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The dermatological
product groups for this study were antibacterial and antifungal drugs, corticosteroids and anti-acne
products and were analysed according to the MIMS classification.
Of all analysed prescriptions issued only 8.57 % (n = 126 447) during 2001 (N = 1 475 380) and
6.82 % (n = 177 122) during 2004 (N = 2 595 254) consisted of dermatological products. Of the
total number of products prescribed, the dermatological products constituted 4.77 %I
(n = 140 701) for 2001 (N = 2 95 1 326) and 3.77 % (n = 199 976) for 2004 (N = 5 305 882). The
total cost of the dermatological products was 4.98 % (n = R18 913 889.92) of the total cost of all
medicine products during 200 1 (N = R379 708 489). During 2004 (N = R66 1 223 146) the total
cost of dermatological products was 4.09 % (n = R27 025 540.48) of the total cost of all
medicine products in the database. The cost-prevalence index for 2001 and 2004 respectively
showed that the dermatological products were relatively expensive with values of 1.03 and 1.09.
The antibacterial and antifungal drugs, corticosteroids and anti-acne products represented 91.92
% (n = 129 336) and 87.97 % (n = 175 9 16) of all dermatological products during 2001 (N = 140
701) and 2004 (N = 199 976), respectively. These dermatological groups named above
represented 91.57 % (n = R17 319 645.61) and 85.85 '% (n = R23 200 594.71), respectively, of
the total cost of dermatological products during 200 1 (N = R18 9 13 889.92) and 2004 (N = R27
025 540.48).
It was further found that the majority of dermatological products prescribed during the research
periods was innovator products. The prevalence of innovator products for 2001 was 86.17 % (n
= 12 1 249) with a total cost representing 94.16 % (n = R17 809 603.12). For 2004 the prevalence
was 82.33 % (n = 164 640) with a total cost representing 91 .O1 '% (n = R24 594 923.72) of all the
dermatological products prescribed. The number of innovator and generic products claimed
during 2001 amounted to 86.17 % (n = 12 1 249) and 13.83 % (n = 19 452) respectively of the
total number of products claimed (N = 140 701). During 2004 the number of innovator and
generic products represented respectively 82.33 % (n = 164 640) and 17.67 O/o (n = 35 336) of the
total number of products claimed (N = 199 976).
The prevalence in the use of the dermatological products during 2004 increased with 55.25 %
from January to April versus September to December. The cost-prevalence index indicated that
the dermatological products were relatively expensive during January to August 2004. During
September to December 2004 the cost-prevalence decreased and indicated that dermatological
products became inexpensive.
The average cost of dermatological products during the 2004 study period showed that the cost
decreased. January to April (before implementation of the new single exit price structure) was
compared to September to December (after implementation of the new single exit price
structure). This comparison indicated that the average cost decreased by 22.88 %.
It can be summarised that the average cost in the last study period decreased due to the changed
price structure. The innovator products' prevalence was high and therefore more generics are
needed in dermatology. If more generics are used the total cost of dermatological products
might also decrease. The number of dermatological prescriptions increased towards 2004, but
this may be because of more members or more medical aids claiming through this database.Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2006.
2
Mizuno, Kayoko. "Indications and outcomes of paediatric tracheotomy: a descriptive study using a Japanese claims database." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/263525.
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3
McCulloch, Matthew, and Alysson Baumgart. "A Comparison of Two Methods of Medication Reconciliation." The University of Arizona, 2008. http://hdl.handle.net/10150/624320.
Full textAbstract:
Class of 2008 AbstractObjectives: To compare the completeness of patient medication history collected upon admission at the University Medical Center (UMC) in Tucson, Arizona with that collected by RxAccordTM insurance claims database. Methods: An inferential retrospective chart review. A random list of 300 patients admitted to UMC from January 1, 2007 to June 30, 2007 who utilized specific insurance companies was obtained. Of those 300 patients, the first 100 patients found in the RxAccordTM database were included in this study. UMC recorded admission medication history was noted for each patient and compared against the RxAccordTM retail pharmacy adjudicated medication database. The main outcome measured was the number of medication discrepancies. The independent variable was the type of medication reconciliation conducted (RxAccordTM ) vs. physician compiled upon admission to UMC. Results: A total of ninety-five charts were used in this study. UMC admission medication reconciliation records had an average of 2.21 missing medications per patient whereas RxAccordTM had an average of 1.01 missing medications per patient. Of the medications missing on the RxAccordTM database, almost 50% (46/96) were OTC medications. On average, UMC had fifty-one medications that had discrepancies (i.e. route, strength or directions). On the other hand, RxAccordTM contained no discrepancies. A total of 17 out 95 records (18%) were missing medication reconciliation forms in their medical record. Conclusions: Information collected by RxAccordTM produced a more complete patient medication reconciliation history than that compiled upon admission at UMC. An insurance claims database may provide, a significantly more accurate method of medication reconciliation.
4
Mohammed, Sheila. "Evaluation of Occupational Risk Factors for Nurses and CNAs: Analysis of Florida Workers' Compensation Claims Database." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4731.
Full textAbstract:
Musculoskeletal injuries lead to most claims even though needlestick injuries receive the most attention. In 2010, health expenditures in the United States neared $2.6 trillion. CNAs, orderlies, and attendants had the highest rates of musculoskeletal disorders of all occupations with an incidence of 249 per 10,000 compared to 34 per 10,000 for all workers. The financial burden of back injuries in the healthcare industry is estimated to add up to $20 billion annually. Data was extracted for cause of injury, nature of injury and body part injured. Extracted data was analyzed both descriptively and by logistic and linear regression using SAS version 9.2. Results were significant for falls, lifting, being struck and pushing and pulling as major causes for injury. Regarding the nature of injury, sprains and strains constituted the majority of claims. The lower back was the body part most commonly injured in a claim. It was concluded that emphasis must be placed on risk factors for musculoskeletal injuries such as falls, lifting, temporal and environmental factors, age and lifestyle factors rather than needlestick injuries.
Results from this study will be used to characterize risk factors for occupational injuries in CNAs and nurses, and to devise and implement preventive measures, including new legislation, to curb such injuries.
5
Takeda, Chikashi. "Prophylactic sivelestat for esophagectomy and in-hospital mortality: a propensity score-matched analysis of claims database." Kyoto University, 2020. http://hdl.handle.net/2433/253147.
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6
Takeshima, Nozomi. "Continuation and discontinuation of benzodiazepine prescriptions: A cohort study based on a large claims database in Japan." Kyoto University, 2016. http://hdl.handle.net/2433/215956.
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7
Lodi, Sara. "Statistical Issues in using A Large Claims Database to Study the anti-inflammatory effect of statins in Rheumatoid Arthiritis." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499290.
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8
Burger, Johanita Riétte. "A drug utilisation review of the concept of metabolic syndrome using a South African medicines claims database / Burger JR." Thesis, North-West University, 2012. http://hdl.handle.net/10394/8072.
Full textAbstract:
The aim of the study was to determine the prevalence, medicine prescribing patterns and direct treatment cost associated with the metabolic syndrome and its components in the private health care sector of South Africa. A two–dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide background to the study by conceptualising the metabolic syndrome and the components forming part thereof. The empirical investigation consisted of a descriptive, quantitative, retrospective drug utilisation review study, utilising medicine claims data sourced from a South African Pharmaceutical Benefit Management (PBM) company for the period January 1, 2005 to December 31, 2008. Data for a total 246 122 patients from 2005, 252 080 from 2006, 208 632 from 2007 and 196 242 from 2008, receiving at least one medicine item from the pharmacological medicine classes of antihypertensives (including diuretics, MIMS® classifications 7.3 and 16.1), hipolipidaemics (MIMS® classification 7.7) and antidiabetics (MIMS® classification 19.1) were analysed. Metabolic syndrome was defined according to the American Heart Association/National Heart, Lung and Blood Institute criteria, as patients with claims for 1 medicine item(s) per year from each of these drug classes.
Seventy one per cent (n = 261 036) of patients from 2005 met one risk selection criterion for the metabolic syndrome, compared with 69.9% from 2006 (n = 269 452), 66.6% (n = 226 264) from 2007 and 64.9% (n = 214 109) from 2008 (male:female ratio 1:1.5 for 2005–2008; age peak >45,60 year). A total 60 683 (4.0%, n = 1 509 621) of patients from the 2005 dataset met at least two risk criteria for the metabolic syndrome. This number of patients increased to reach 63 835 (4.1%, n = 1 558 090) in 2006, thereafter decreasing to 57 992 (4.9%, n = 1 178 596) in 2007 and 57 220 (5.9%, n = 974 497) in 2008. A total 5.7% (n = 246 122) of patients in 2005 met inclusion criteria for the metabolic syndrome, increasing to 6.5% (n = 252 080) in 2006, 7.8% (n = 208 632) in 2007 and 8.3% (n = 196 242) in 2008 (male to female ratio for 2005 – 2008:1.2:1). In general, prevalence increased from ~0.1% of patients aged >0,15 years to ~0.3% in those >15,30 years, ~6% in patients >30,45 years, ~40% in patients aged >60,75 years and ~20% in patients >75 years. The average prevalent age appeared earlier in males than in females by 2 years.
The average pill burden per prescription for patients from the 2005–metabolic syndrome category was 2.6 ± 1.43, compared with 2.6 ± 1.47 in 2006, 2.7 ± 1.52 in 2007 and 2.7 ± 1.53 in 2008, with a maximum of 16 items claimed per patient in 2005, 14 in 2006 and 2007, respectively and 19 in 2008. Antidiabetics, hipolipidaemics and antihypertensives were claimed in a ratio of 1:1:2 across the 4–year study period. A prescribing index of 20 medicine items (active substances) based on prescribing volume was established for metabolic syndrome patients; the 5 most claimed medicine items on this index was metformin, simvastatin, atorvastatin, insulin and gliclazide.
A total of 17 716 different treatment regimens was identified for patients from the 2008–metabolic syndrome category, containing from one to 12 different active substances per regimen. Overall 90.7% (n = 17 716) of treatment regimens contained between 3 and 7 different active substances per prescription; a further 3.3% contained 8 active substances each. The combination of indapamide and perindopril with amlodipine, or simvastatin and/or metformin had the highest prevalence among those regimens containing 3 active substances.
The total direct medicine treatment cost from the metabolic syndrome category amounted to R71.7 million in 2005, increasing to R94.7 million in 2008. Medical aid schemes contributed 90.0% (n = R71 724 445.88) towards these costs in 2005, decreasing to 86.0% (n = R94 690 393.54) in 2008. The average scheme contribution was R131.14 ± 135.64 (median R103.12) per medicine item in 2005, compared with R126.63 ± 133.65 (median R101.24) in 2006, R128.39 ± 141.69 (median R101.35) in 2007 and R122.45 ± 143.97 (median R94.27) in 2008. Patients paid the excess 10% (2005) to 14% (2008) of costs out–of–pocket for co–payments on medicine items at an average cost of R14.55 ± 34.26 (median R0.00) per item for 2005, compared with R15.80 ± 38.04 (median R0.00) during 2006, R16.61 ± 38.01 (median R0.00) in 2007 and R19.95 ± 40.06 (median R2.28) in 2008. The average annual direct medicine treatment cost for a patient from the metabolic syndrome category summed to R4 809.20 ± 4 057.46 (median R3 850.67) in 2005, compared with R5 053.34 ± 4 033.85 (median R4 041.16) in 2006, R5 503.88 ± 4 348.67 (median R4 357.79) in 2007 and R5 300.03 ± 4 433.93 (median R4 100.06) in 2008.
A total 7 050 patients (39.5%, n = 17 866) or approximately every third patient from the metabolic syndrome category had at least one other Chronic Disease List (CDL) condition during 2008. An average chronic disease count of 1.4 ± 0.63 (median 1) (range: 1–5) per patient was calculated. Diseases that co–occurred most were hypothyroidism (22.7%, n = 7 050), coronary artery disease (13.6%, n = 7 050), cardiac failure (10.7%, n = 7 050), asthma (7.3%, n = 7 050) and glaucoma (4.5%, n = 7 050).
In conclusion, this study established base–line estimates on the prevalence, medicine prescribing patterns and associated direct medicine treatment cost of patients with metabolic syndrome and/or those at risk for the development thereof in the private health care sector of South Africa, as defined by surrogate measures of criteria from the American Heart Association and National Blood Institute. Recommendations for future extensions and diversifications to the study were made.Thesis (PhD (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.
9
Seletswane, Dineo Precious. "Usage patterns and cost analysis of angiotensin-converting enzyme (ACE) inhibitors using a medical aid claims database / Dineo Precious Seletswane." Thesis, North-West University, 2004. http://hdl.handle.net/10394/357.
Full textAbstract:
ACE inhibitors have been widely used in the treatment of certain diseases of the
cardiovascular system, the major use being hypertension, since all ACE inhibitors are
prescribed for its treatment. ACE inhibitors is also used in the treatment of congestive
heart failure.
The angiotensin-converting enzyme (ACE) converts angiotensin 1 into angiotensin I1
and also stimulates the production of aldosterone (a hormone produced in the adrenal
glands that influences salt and water retention by the kidneys, increasing blood
volume and blood pressure).
The cost benefit, cost-effectiveness and cost utility of ACE inhibitors have not been
established. The objective of the study was to review and analyse the cost of ACE
inhibitors by using a medical aid claims database.
Data for the study population consisted of all prescriptions containing one or more
ACE inhibitor combinations and were extracted from the central database of
Interpharm datasystems for a period of one year, from 1 January 2001 to 31
December 2001. A total of 1 475 532 prescriptions containing a total of 2 953 244
ACE inhibitor items represented the study population.
Through the analysis of the general medicine utilisation patterns that were obtained
from the medicine claims database, it became evident that ACE inhibitor utilisation
contributes considerably to the total prevalence and cost of all the medicine items
available on the database. It constituted a total prevalence of 4,62% (n =1 475 532) of
all the prescriptions and a total prevalence of 2,31% (n =2 953 244) for all the
medicine items in the prescriptions with a cost of 3,65% (n =R379 91 1 472,OO).
It was concluded that in the analysis of ACE inhibitors according to the
innovator/generic classification, the majority of ACE inhibitors prescribed during the
twelve-month period were for the innovator product, with a prevalence of 82,56% (n
=68 162) and a cost of 89,11% (n =R13 863 080, 90). The utilisation of the generic
ACE inhibitors, with a prevalence of 17,44% (n =68 162) and at a cost of 10,89% (n
=R13 863 080, 90), was under-utilised. If the total number of prescriptions containing
innovator ACE inhibitors could be generically substituted, (37,54%) R5 204 392,68 in
cost expenditure could be saved over a twelve-month period. However, the fact that
not all the innovator ACE inhibitors have generic equivalents available must be taken
into account. If only the prescriptions containing ACE inhibitor items that have
generic equivalents were to be substituted with their generic equivalents, R899
751.29(6.5%) would be saved. This was found by adding all the costs saved by
substituting innovator drugs with their generics.
Consequently, it can be concluded that the extensive use of the innovator ACE
inhibitors could mean an exceptional increase in the cost expenditure associated with
ACE inhibitor therapy.
In completion of the study, recommendations were formulated as an aim to optimise
the utilisation of ACE inhibitor generic equivalents.Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2004.
10
Van, Zyl Tiaan. "A longitudinal analysis of the prescribing patterns of anti–epileptic medicine by using a medicine claims database / T. van Zyl." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4918.
Full textAbstract:
The prevalence of epilepsy in society is general knowledge; however the impact on
social activity as well as other daily factors are not always fully recognised. Epilepsy
frequently poses a problem with regard to work–related activities (Heaney, 1999:44).
Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work
and school difficulties, driving prohibition, psychological and social life of which
restriction of work or schooling has the greatest impact on epileptic’s life. In all cases
the type, severity, and frequency of the seizures as well as the age would be relevant.
Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their
therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic
medicine appears to be related to increased health care utilisation and costs
and may also lead to an increased probable accidents or injuries
The general objective was to investigate anti–epileptic medicine prescribing patterns
and treatment cost in a section of the private health care sector by using a medicine
claims database.
A retrospective drug utilisation study was done on the data claims from a pharmacy
benefit management company for the study period 1 January 2005 to 31 December
2008.
Firstly epilepsy was investigated in order to understand the disease and to determine
the prevalence and treatment thereof. It was found that epilepsy is still one of the most
common neurological conditions and according to the findings, 2 out of every hundred
patients were using anti–epileptic medicine in this section of the private health care
sector. To make this condition socially more acceptable and understandable, public
education for special target groups concerning the disorder must be conducted as well
as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted.
It was determined that anti–epileptic medicine items are relatively expensive with
regards to other medicine items on the total database. With regard to gender, more
females are using anti–epileptic medicine than males on the database. The largest age
group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of
age. It was also clear that prevalence increase as age increase.
With regard to the different prescribers, the number of items prescribed by a general
practitioner was almost double that of the other prescribers. It was further established
that newer anti–epileptic medicines are more expensive than older anti–epileptic
medicine according to the cost per tablet in this section of the private health care
sector.
Carbamazepine and valproate were the two active ingredients that were most
frequently prescribed as a single item on a prescription. After a cost–minimisation
analysis was done, R134 685.66 could have been saved when generic substitution was
implemented.
The refill–adherence rate decreased as age increased. Only 30.46% of the trade
names was refilled according to acceptable refill–adherence rates. The refill–adherence
rate according to active ingredient showed that medicine items containing,
phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate.
The limitations for this study was stipulated and recommendations for further research
regarding anti–epileptic medicine were also made.Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.
11
Janse, van Rensburg Hendrika Nicolien. "A longitudinal study of the usage of acid reducing medicine using a medicine claims database / Hendrika Nicolien Janse van Rensburg." Thesis, North-West University, 2007. http://hdl.handle.net/10394/1903.
Full textAbstract:
Acid-related disorders are common, chronic conditions that have considerable impact on a patient's quality of life. In a study conducted by Majumdar et al. (2003:2411) the prevalence of chronic acid-related disorders was 2.3%. Acid-related disorders represent a major financial consideration with respect to the costs of drug prescribing (Whitaker, 1998:6). Health care cost increases each year. This leads to an increased interest in economic evaluation of health care and medical technologies (Anell & Svarvar, 2000:175). Health care providers no longer make treatment decisions independent of the consideration of the resultant cost. The treatment provided must not only provide value but the value must be documented to justify spending money. Economic evaluation research has emerged to offer guidance to policy makers, practitioners, health plans and institutions facing difficult treatment and coverage decisions (Ellis era/., 2002:271).
The main objectives of this study were to investigate the prescribing patterns and cost of acid reducing medicine with special reference to proton pump inhibitors and histamine-2 receptor antagonists in a section of the private health care sector of South Africa from 2001 to 2006. A longitudinal retrospective drug utilisation study was done on acid reducing medicine items claimed through a national medicine claims database. The five study years were 2001, 2002, 2004, 2005 and 2006. All the study years stretched from 1 January to 31 December.
It was determined that acid reducing medicine items prescribed decreased from 2.74% during 2001 to 2.50% during 2006 of all medicine items claimed. The same decreasing trend was observed regarding the cost of acid reducing medicine items. The cost percentage decreased from 4.89% (2001) to 3.72% (2006). However, the average cost per medicine item for the acid reducers increased by 5.35% from 2001 (R230.04 ± 176.29) to 2002 (R243.72 ± 184.18) and then decreased by 15.23% from 2002 to 2004. It again decreased with 15.05% from 2004
(R206.19 ± 179.42) to 2006 (R175.70 ± 172.55). The changes in the average cost of acid reducers were of no practical significance.
Proton pump inhibitors represented about half of the acid reducing medicine items prescribed and more than 70% of the total cost of acid reducing medicine items during the study years. The average cost of PPIs revealed a practical significant decrease (d > 0.8) from 2002 (R372.42 ± 156.62) to 2006 (R241.56 ± 177.21). H2RAs contributed between 15.00% and 18.26% of all acid reducing medicine items while contributing to between 9.68% and 16.85% of the total cost of all acid reducers.
The active ingredient most often prescribed was lansoprazole during 2001 and 2002, esomeprazole during 2004 and omeprazole during 2005 and 2006. Lanzor® 30mg was the acid reducer with the highest cost from 2001 to 2005, while Pariet® 20mg took the lead in 2006. Zantac® 150mg effervescent tablets were the H2RA, with the highest cost, during the five study years.
The percentage innovator items decreased by 4.50% from 2001 to 2002, increased by 1.01% from 2002 to 2004 and decreased again by 31.06% from 2004 to 2006. The slight increase in the percentage innovator medicine items claimed from 2002 to 2004 may be explained by the introduction of Nexiam® (esomeprazole) into the market in 2002. The total number of generic medicine items claimed contributed between 9.62% (n = R1 788 242.25) in 2001 and 30.75% (n = R3 196 163.34) in 2006 of the total cost of acid reducing medicine items.
The average cost per day of innovator medicine items was higher than the average cost per day of generic medicine items. This might be explained by a lower average cost for generic medicine items.
It was also determined that the prevalence of the two-drug regimens was the highest during the five study years. The Helicobacter pylori (H.pylori) eradication treatments, which included different antibiotics, increased from 2.72% in 2001 to 5.05% in 2006.
The PDD for most of the active ingredients of H2RAs and PPIs remained stable during the study years. However, it appears that the PDDs, of the PPIs, active ingredients were more constant than the PDDs, or the H2RAs, active ingredients. The median of the different PPI active ingredients was reasonably more constant than the median of the different H2RA active ingredients. Thus the changes between the PPIs' and H2RAs' active ingredients might be explained by the variation in the median (the number of days the relevant medicine item was claimed for).
It is then also recommended that the aspects of generic substitution as well as the usage of H2RAs as prescribed vs. self medication should be further investigated to increase possible cost savings.Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.
12
Mothemela, Mokgadi. "Mesothelioma in South Africa 3 decades post peak of asbestos production an analysis of a claims database of asbestos ex-miners." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10992.
Full textAbstract:
Includes bibliographical references.The peak in production of the three forms of asbestos that were commercially mined in South Africa occurred in the years between 1970 and 1977. Given the latency period of 20-40 years, we should expect to observe a rise in the incidence of mesothelioma throughout this decade. However, all we may ever observe is just the surface of what may be an immeasurable burden of disease due to amongst other reasons, the lack of representative data and the nature of mesothelioma itself. As a result of the obstacles that impeded earlier research, South African studies that have been conducted since Wagner et al. first established the association between asbestos and mesothelioma in 1960, have reported under estimated measures of occurrence of the disease, especially amongst black examiners. It also due to the exploitation and injustice to former miners throughout the asbestos mining history that we remain with an unknown burden and epidemiology of disease as well as heavy costs towards healthcare and rehabilitation of mine dumps. The author sought to review the medical information of claimants registered on an asbestos compensation database hosting the largest number of black asbestos ex-miners of all case series published in South Africa to date. The aim was to describe the demography and the epidemiology of the disease amongst those who had been diagnosed with mesothelioma between 2003 and 2010. The protocol (PART A) describes a brief background of the two Trusts on which this study was based, and the methodology of the study. The literature review (PART B) illustrates the conditions that prevailed in the asbestos mining industry and how these have distorted the epidemiology of mesothelioma in South Africa. The manuscript of the article (PART C) illustrates the data analysis, the results, as well as the discussion of the results. The objective was to describe the proportions of mesothelioma cases within the database by various characteristics. We also described by race the investigations that the claimants underwent to reach the diagnosis. The results showed that out of the 15 461 claimants registered on the database, 295 (1.91%) had mesothelioma. Of these, 54.24 % were black, 7.80% coloured and 37.97% white. There were more men (76.69%) than women (23.39%).
13
Scheer, Darren. "Respiratory Infections and Risk for Development of Narcolepsy: Analysis of the Truven Health MarketScan Database (2008 to 2010) with Additional Assessment of Incidence and Prevalence." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7927.
Full textAbstract:
Background and Significance: Narcolepsy is a chronic neurological disorder. These patients experience various psychiatric and physical comorbid diseases and mortality at an increased rate compared to the general population. Additionally, patients with narcolepsy experience approximately a doubling of various annual healthcare related facility visits, transactions, and costs comparatively. Narcolepsy with cataplexy is generally believed to be more prevalent than narcolepsy without cataplexy. However, incidence and prevalence estimates of narcolepsy (with or without cataplexy) vary widely with few large epidemiological studies conducted worldwide and none in the U.S evaluating these proportions in both children and adults utilizing a large health care claims database.
One of the main mechanisms underlying narcolepsy, the destruction of hypocretin neurons, is not clear. Two of the more noted hypotheses for this pathology are autoimmune and infection based triggers in allele carrier patients. These have been highlighted since narcolepsy diagnoses increased following the late 2000s influenza vaccinations, especially across Europe. Specific influenza and streptococcal infections have also been considered. Large U.S. healthcare claims database investigations of the association between specific infections and development of narcolepsy were not found in the published scientific literature. Our goals were to enhance the knowledge regarding the epidemiology and possible infection triggers of narcolepsy. The information gained may aid in the overall understanding of the condition, the possible vulnerable populations, and lead to hypotheses regarding which subpopulations research should be focused upon and those triggers that may be avoided or reduced in exposure.
Methods: The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 with continuous enrollment for years 2008-2010. THMCDD contains health claims information for over 18 million people. Prevalence was expressed as cases/100,000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with MSLT, and the diagnosis) was expressed as new cases/100,000 persons/year. Subsequently, we conducted a case-control study to assess the differences in respiratory infections between patients with incident narcolepsy diagnosis and controls. Continuously enrolled patients under age 66 were included. Cases of narcolepsy occurring from July 1, 2009 through December 31, 2010 were included based on two diagnosis criteria (using varying criteria for latency between diagnosis and the diagnostic tests). Non-narcolepsy controls were frequency matched on look-back time by assigning an index date equal to a case diagnosis date. Occurrence of prior respiratory infections was compared between cases and controls based on narcolepsy criteria and four different time periods pre-index date. Infections were grouped into 9 types based on pathogen and clinical manifestation.
Results: From 2008 through 2010, there were 8,444,517 continuously enrolled patients and 6,703 diagnosed with narcolepsy (prevalence overall:79.4/100,000; without cataplexy:65.4/100,000; with cataplexy: 14.0/100,000). Based on the 3 definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100,000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central U.S. had the highest prevalence and incidence, while the West was the lowest. For the case-control study, Adjusted odds ratio (aOR) increases were statistically significant for Group 5 (acute respiratory infections), Group 8 (other pneumonias, bronchopneumonia, etc.) and Group 9 (influenzas) across various time periods pre-index date and for both narcolepsy criteria. Overall, the most significant aORs were for acute respiratory infections during the 3 to 15 months pre-index date for both narcolepsy diagnosis criteria (aOR=1.73, 95% 1.52 to 1.98 and aOR=1.83, 95% CI 1.57 to 2.19). The aORs for acute respiratory infections were approximately 50% greater among females than males.
Conclusion: We observed higher prevalence and incidence of narcolepsy compared to most previous studies. Females were associated with approximately 50% increased proportions compared to males. We also found that the greatest prevalence and incidence of narcolepsy occurred in patients in their early 20s, and those residing in the North Central region of the U.S. Perhaps most striking was the observation of much greater proportions of narcolepsy without cataplexy compared to narcolepsy with cataplexy. In the case-control assessment, we found increased occurrences of acute respiratory infections, pneumonias, and influenza prior to incident narcolepsy diagnosis, compared to controls. Generally, these rates appeared higher for females than males and occurred for both narcolepsy diagnosis criteria. Additionally, these associations were observed in the infection assessment periods 3 to 15 months and 6 to 18 months prior to incident narcolepsy diagnosis. Increased awareness and early notification among healthcare providers for signs and symptoms of narcolepsy is critical in helping this population of patients manage this burdensome condition. Also, the identification of potential narcolepsy triggers by certain infections may aid in the understanding of the disease. These findings may have implications in the understanding of mechanisms and causation of other acute onset neurological disorders. Our observations of consistently increased risk of incident narcolepsy related to recent previous viral respiratory infections and the inconsistent results for bacterial infections require additional study to confirm these findings.
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Xia, Ying. "Risk of Acute Liver Injury Associated with the Use of Orlistat: Cohort and Self-Controlled Case Series Studies Using the MarketScan® Commercial Claims Database." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1490354985131296.
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Takizawa, Osamu. "Price difference as a predictor of the selection between brand name and generic statins in Japan." 京都大学 (Kyoto University), 2016. http://hdl.handle.net/2433/215464.
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Seta, Takeshi. "Status of use of protease inhibitors for the prevention and treatment of pancreatitis after endoscopic retrograde cholangiopancreatography: An epidemiologic analysis of the evidence-practice gap using a health insurance claims database." Kyoto University, 2020. http://hdl.handle.net/2433/254495.
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Chen, Yan. "Comparisons and applications of quantitative signal detections for adverse drug reactions (ADRs) an empirical study based On The food And drug administration (FDA) adverse event reporting system (AERS) and a large medical claims database /." Cincinnati, Ohio : University of Cincinnati, 2008. http://www.ohiolink.edu/etd/view.cgi?acc_num=ucin1203534085.
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Thesis (Ph.D. of Pharmacy Practice and Administrative Sciences)--University of Cincinnati, 2008.Advisor: Jeff Guo PhD. Title from electronic thesis title page (viewed May 9, 2008). Keywords: data mining algorithms; adverse drug reactions; adverse event reporting system; signal detection; case-control study; antipsychotic; bipolar disorder. Includes abstract. Includes bibliographical references.
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CHEN, YAN. "Comparisons and Applications of Quantitative Signal Detections for Adverse Drug Reactions (ADRs): An Empirical Study Based On The Food And Drug Administration (FDA) Adverse Event Reporting System (AERS) And A Large Medical Claims Database." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1203534085.
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Bosco-Lévy, Pauline. "Heart failure in France : chronic heart failure therapeutic management and risk of cardiac decompensation in real-life setting." Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0348.
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En France, environ un million de personnes seraient touchées par l’insuffisance cardiaque (IC) ; on recense près de 70 000 décès liés à l’IC, et plus de 150 000 hospitalisations et cela, malgré une prise en charge thérapeutique bien codifiée. Ces chiffres devraient s’accroitre dans les années futures du fait notamment du vieillissement de la population.L’objectif de ce travail était d’étudier l’utilisation des traitements pharmacologiques indiqués dans le traitement de l’IC (beta bloquant, inhibiteur de l’enzyme de conversion, anti-aldostérone, antagoniste des récepteurs à l’angiotensine II, diurétiques, digoxine, ivabradine) en situation réelle de soin, et d’identifier les facteurs cliniques ou pharmacologiques associés à la survenue d’un épisode de décompensation cardiaque.Un premier travail a permis de mesurer la fiabilité des bases de données médico-administratives françaises pour identifier des patients IC.Une deuxième étude a permis d’estimer que 17 à 37% de patients IC n’étaient exposés à aucun traitement de l’IC dans l’année suivant une première hospitalisation pour IC.Les troisième et quatrième parties de cette thèse ont mis en évidence qu’environ un quart des patients IC étaient réhospitalisés dans les 2 ans suivant une première hospitalisation. Les principaux facteurs cliniques prédictifs de cette réhospitalisation étaient l’âge, l’hypertension artérielle, la fibrillation auriculaire et le diabète. L’association retrouvée entre l’utilisation de fer bivalent et la réhospitalisation pour IC, souligne l’importance du risque lié à la présence d’une anémie ou d’une déficience en fer dans la survenue d’un épisode de décompensation cardiaque.Ces résultats permettent de reconsidérer la prise en charge thérapeutique chez les patients IC et mettent en avant la nécessité de renforcer la surveillance des patients les plus à risque de décompenser leur ICIn France, around one million persons would be affected by heart failure (HF); there are nearly 70 000 deaths related to HF and more than 150 000 hospitalizations despite a well defined treatment management. These numbers should increase in the next years due in particular to the ageing of the population.The objective of this work was to study the use of the pharmacological treatments indicated in HF (beta-blocker, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, diuretics, digoxin, ivabradine) in real-world setting and to identify the clinical or pharmacological predictors associated with a new episode of cardiac decompensation.A first work has enabled to estimate the accuracy of French claims databases in identifying HF patients.A second study estimated that 17 to 37% HF patients were not exposed to any HF treatment in the year following an incident HF hospitalization.The third and fourth parts of this thesis showed that almost one forth of HF patients was rehospitalized within the 2 years following a first hospitalization. The main clinical predictors of rehospitalization were age, high blood pressure, atrial fibrillation and diabetes. The association found between bivalent iron use and HF rehospitalization underlines the importance of the risk related to anemia or iron deficiency in the occurrence of a cardiac exacerbation episode.These results allow to reconsider the treatment management of HF patients and highlight the need to reinforce the surveillance of patients with a highest risk of cardiac exacerbation
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Squitieri, Chris. "Matching Observations Found in Texas Department of Insurance’s Medical Malpractice Claim Data and the National Practitioners Database." Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/cmc_theses/1041.
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In regards to health care, the civil tort system serves to both deter negligent behavior on the part of the provider and compensate victims for losses which must include bodily harm attributable to negligent medical care. Due to the unique malpractice landscape that evolved in the United States, national tort reform has increased over the last several decades and a need for reliable data exists. This paper matches claims from the National Practitioner's Data Bank to an independent state data bank to determine is systematic, nonrandom differences between the observations exist. The paper found that systematic differences existed and their existence was implicitly proven in a paper published in 2013. This calls into question the current state of knowledge surrounding medical malpractice liability reform.
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Bian, Boyang. "Exploring and Developing Algorithm of Predicting Advanced Cancer Stage of Colorectal Cancer Based on Medical Claim Database." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396522857.
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Kurowski, Dušan. "Návrh a zavedení systému sběru informací o spolehlivosti stroje." Master's thesis, Vysoké učení technické v Brně. Fakulta strojního inženýrství, 2008. http://www.nusl.cz/ntk/nusl-228237.
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This diploma thesis is engaged in a system design, which is created to be used for warranty claims data collection. The issue of the second part of this document is the implementation of the system and the description of the next analyse for warranty claims costs minimalisation.
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Sudhindaran, Daniel Sushil. "Generating a Normalized Database Using Class Normalization." UNF Digital Commons, 2017. http://digitalcommons.unf.edu/etd/727.
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Relational databases are the most popular databases used by enterprise applications to store persistent data to this day. It gives a lot of flexibility and efficiency. A process called database normalization helps make sure that the database is free from redundancies and update anomalies. In a Database-First approach to software development, the database is designed first, and then an Object-Relational Mapping (ORM) tool is used to generate the programming classes (data layer) to interact with the database. Finally, the business logic code is written to interact with the data layer to persist the business data to the database. However, in modern application development, a process called Code-First approach evolved where the domain classes and the business logic that interacts with the domain classes are written first. Then an Object Relational Mapping (ORM) tool is used to generate the database from the domain classes. In this approach, since database design is not a concern, software programmers may ignore the process of database normalization altogether. To help software programmers in this process, this thesis takes the theory behind the five database normal forms (1NF - 5NF) and proposes Five Class Normal Forms (1CNF - 5CNF) that software programmers may use to normalize their domain classes. This thesis demonstrates that when the Five Class Normal Forms are applied manually to a class by a programmer, the resulting database that is generated from the Code-First approach is also normalized according to the rules of relational theory.
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Watanabe, Toyohide, Yuusuke Uehara, Yuuji Yoshida, and Teruo Fukumura. "A semantic data model for intellectual database access." IEEE, 1990. http://hdl.handle.net/2237/6923.
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Fatrdla, Pavel. "Porovnání technologií pro objektově relační mapování." Master's thesis, Vysoké učení technické v Brně. Fakulta informačních technologií, 2010. http://www.nusl.cz/ntk/nusl-237102.
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Diploma thesis deals with the contemporary object-relational mapping (ORM) technologies for Java. It briefly describes also competing technologies for persisting objects in files, object and object-relational databases. However main part of the thesis is the persistence of objects in relational databases using ORM frameworks. The work begins with studying general methods and issues, that these frameworks have to solve. Next, it chooses and deeply describes some ORM frameworks. They are later demonstrated on the demo application. In the following part there is a description of the problems I have been facing during the implementation of the persistence using these frameworks. Finally, there is an evaluation and a comparison of these frameworks.
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Nakaoka, Sachiko. "Prescribing pattern of anti-Parkinson drugs in Japan: a trend analysis from 2005 to 2010." 京都大学 (Kyoto University), 2014. http://hdl.handle.net/2433/193574.
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Nakaoka S, Ishizaki T, Urushihara H, Satoh T, Ikeda S, et al. (2014) Prescribing Pattern of Anti-Parkinson Drugs in Japan: A Trend Analysis from 2005 to 2010. PLoS ONE 9(6): e99021. doi:10.1371/journal.pone.0099021Kyoto University (京都大学)
0048
新制・課程博士
博士(社会健康医学)
甲第18649号
社医博第61号
新制||社医||8(附属図書館)
31563
京都大学大学院医学研究科社会健康医学系専攻
(主査)教授 髙橋 良輔, 教授 川上 浩司, 教授 松原 和夫
学位規則第4条第1項該当
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Mikulka, David. "Pokročilý nástroj pro monitorování Oracle Databáze." Master's thesis, Vysoké učení technické v Brně. Fakulta informačních technologií, 2010. http://www.nusl.cz/ntk/nusl-237133.
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This master's thesis describes possibilities of Oracle Database 10g and 11g monitoring. It let the reader know about practical tools for monitoring and describes the database's internal catalogs preserving statistics and the information about running database instances within history. Next, it describes design of an Oracle database monitoring tool, describtion of its implementation and at the end its evaluation and comparison with other similar applications.
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Belhassen, Manon. "Apport des bases de données médicoadministratives à l’étude du fardeau de la maladie et de la morbidité évitable dans l’asthme et l’ostéoporose." Thesis, Lyon, 2016. http://www.theses.fr/2016LYSE1082.
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En France, l'usage des bases de données médico-administratives dans le cadre épidémiologique est récent comparativement à d'autres pays d'Europe, du fait notamment de leur complexité, liée à leur développement initial mené dans une optique comptable. Les travaux menés ont porté sur l'apport de ces bases de données à l'étude de la prise en charge et de la morbidité évitable dans l'asthme et dans l'ostéoporose. Dans un premier temps, nous avons montré que ces bases de données permettaient au travers d'algorithmes d'identifier des nourrissons asthmatiques et leurs exacerbations, et que la prise en charge de ces nourrissons n'était pas optimale en France, avec une forte consommation d'antibiotiques et de corticoïdes oraux. Nous avons prolongé ces recherches par la description de la prise en charge des asthmatiques enfants/adolescents et adultes, et les constats ont été les mêmes. Une surconsommation des traitements de crise a pu être mise en évidence, ainsi que des sous-groupes de patients à risque d'exacerbation sévère. Ces résultats nous ont amené à nous intéresser tout particulièrement à l'adhésion aux traitements de fond. Dans une étude menée sur 5 000 patients asthmatiques, le taux de couverture par un traitement de fond était en moyenne de 51%, et seuls 24% des patients avaient un taux de couverture supérieur ou égal au taux minimal recommandé (80%). Enfin, concernant l'ostéoporose, nous nous sommes attachés à décrire la prise en charge des patients ostéoporotiques sur une période de 6 ans, en nous concentrant particulièrement sur les changements de stratégies thérapeutiquesAnglais In France, the use of claims data in the epidemiological context is recent compared to other European countries, in particular because of their complexity, linked to their initial development for accounting purposes. This work was focused on the contribution of these databases to study disease management and unmet needs in asthma and osteoporosis. First, we showed that it was feasible, through algorithms, to identify in these data infants with asthma and their exacerbations, and we noted that management of these infants was not optimal, with high use of antibiotics and oral corticosteroids. We extended this research by describing the treatment of asthmatic children/adolescents and adults, with similar findings. Overuse of reliever therapy was observed, beyond the identification of subgroups at risk of serious exacerbation. These results led us to focus on adherence to controller therapy. In a study including 5,000 asthma patients, the coverage by controller therapy was 51%, and only 24% of patients had a higher coverage than the recommended minimum (80%). Finally, regarding osteoporosis, we described the treatment of osteoporotic patients over 6 years, with a particular focus on treatment switches
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Beck, Morgane. "Stratégies de prise en charge de la polyarthrite rhumatoïde : quelle place pour les médicaments biosimilaires ?" Thesis, Strasbourg, 2017. http://www.theses.fr/2017STRAJ039/document.
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Le coût des biomédicaments impacte lourdement le fardeau financier déjà important imposé par la polyarthrite rhumatoïde (PR) à la société. Le but de ce travail était de rechercher les motivations de la prescription des médicaments biosimilaires en rhumatologie, tout particulièrement pour prendre en charge les patients atteints de PR. Les travaux effectués ont permis d’estimer les économies annuelles réalisables en France avec le médicament biosimilaire de l’infliximab à 13,6 millions d’EUR, pour la seule prise en charge de la PR. Par ailleurs, une enquête menée auprès des rhumatologues et pharmaciens a permis d’identifier les principaux enjeux liés à l’utilisation de ces médicaments. Enfin, le suivi de leur utilisation en région Grand Est entre 2015 et 2016 rend compte de leur utilisation encore modeste. La mise sur le marché régulière de médicaments biosimilaires, combinée à l’expérience croissante des acteurs et aux dispositifs d’incitation mis en place, devraient permettre de faire progresser la part d’utilisation de ces médicaments dans les prochaines années, et de s’assurer qu’ils tiennent bien leurs engagements sur le plan des économies réaliséesBiological drugs are associated with high procurement costs and heavily impact the financial burden imposed by rheumatoid arthritis on society. The purpose of this work was to investigate the benefits of using biosimilar drugs in rheumatoid arthritis patients. This work showed the introduction of biosimilar infliximab could lead to substantial annual cost savings of up to €13.6 million nationally, to treat rheumatoid arthritis patients only. Moreover, a biosimilar survey involving rheumatologists and pharmacists allowed us to identify the main issues at stake. Finally, the monitoring of their use in Grand Est region between 2015 and 2016 account for their relatively low utilization rate. The regular launch of new biosimilar medicines, together with growing experience of healthcare players and incentive policies, should allow to increase biosimilar uptake in the future, and also to make sure they meet well their commitments in terms of savings generated
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Thulemark, Maria. "Moved by the mountains : migration into tourism dominated rural areas." Doctoral thesis, Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-43914.
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Maura, Géric. "Utilisation des bases de l'Assurance Maladie pour l'analyse de l'utilisation et de la sécurité des anticoagulants oraux dans la fibrillation auriculaire." Thesis, Bordeaux, 2018. http://www.theses.fr/2018BORD0234.
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En France, depuis 2012, les anticoagulants oraux directs (AOD), indiqués dans la prévention des accidents vasculaires cérébraux chez les patients avec fibrillation auriculaire (FA) non valvulaire, sont une alternative aux antivitamines K (AVK) pour lesquels une sous-prescription et un défaut d’observance ont été largement décrits. L’objectif de cette thèse était, dans le cadre du programme de travail du Département études de santé publique de la Caisse nationale de l’Assurance maladie, d’étudier à partir des bases de données médico-administratives (BDMA) françaises l’utilisation et la sécurité du traitement anticoagulant oral (ACO) en situation réelle de soins chez les patients avec FA. Un premier travail a permis de construire un algorithme pour identifier l’indication FA chez les patients débutant un ACO et pour lesquels aucun diagnostic de FA n’était retrouvé dans les BDMA. Un deuxième travail a porté sur l’évaluation de l’adhésion au traitement ACO chez les nouveaux utilisateurs : au cours de l’année suivant l’initiation du traitement, au moins un patient sur trois arrêtait son traitement, dabigatran ou rivaroxaban, et la persistance à ces traitements n’était pas meilleure que celle des AVK. Un troisième travail a décrit une amélioration de la couverture anticoagulante chez les patients avec FA entre 2011 et 2016. Cependant, un patient sur trois était encore sans traitement ACO en 2016 et de potentiels mésusages à l’instauration du traitement AOD ont été identifiés, dont un signal de sous-dosage. Enfin, une analyse en symétrie de séquences a suggéré que l’initiation des AOD serait associée à la survenue rare d’atteintes toxiques aiguës du foie et à la survenue plus fréquente de troubles gastrointestinaux. Avec la description de la population et de l’utilisation rejointes des traitements ACO en France chez les patients avec FA, ces résultats encouragent la poursuite de la surveillance des effets indésirables non hémorragiques des AOD et l’amélioration de leur utilisationDirect oral anticoagulants (DOAC) were gradually introduced since 2012 in France for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation (AF), as a more convenient alternative to vitamin K antagonists (VKA) for which underprescribing and high rates of discontinuation have been frequently reported. As part of the work programme of the Department of Studies in Public Health, French National Health Insurance, the aim of this dissertation was to assess the patterns of use and safety of oral anticoagulant (OAC) therapy in real-life setting using the French healthcare databases. First, an algorithm was developed to identify AF in outpatients initiating OAC and for whom no diagnosis of AF was found in the French claims data. Second, 1-year dabigatran and rivaroxaban adherence rates were estimated in nonvalvular AF patients and 1-year non-persistence rates were compared versus VKA. At least 1 in 3 dabigatran or rivaroxaban new users was found to be non-adherent to treatment. Treatment persistence among dabigatran or rivaroxaban new users was not found to be better versus VKA therapy. Third, OAC therapy use was found to have increased following in France between 2011 and 2016 but remained suboptimal with 1 in 3 patients with AF not treated by OAC therapy. Several situations of inappropriate use of DOAC were identified including potential undertreatment by inappropriate dosing. Finally, a sequence symmetry analysis suggested that DOAC therapy is associated with rare but severe liver injury and more frequent gastrointestinal disorders. A low risk of kidney injury with DOAC therapy can also not be excluded. These findings advocate further investigation of the potential risk of DOAC underdosing at initiation and the continuous monitoring of the non-bleeding adverse events of DOAC therapy
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Cohen, Sarah. "Apport et utilisation des bases de données médico-administratives dans l’étude des problématiques émergentes chez les patients adultes atteints de cardiopathie congénitale Administrative health databases for addressing emerging issues in adults with CHD: a systematic review Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB228.
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Les cardiopathies congénitales (CC) sont les plus fréquentes des malformations congénitales et concernent près de 1% des naissances. Grâce aux progrès considérables de la cardiologie pédiatrique et de la chirurgie cardiaque, 90% des enfants nés avec une CC atteignent désormais l'âge adulte. Mais ces « survivants » ne sont pas guéris. Un certain nombre de complications, cardiaques et extracardiaques, attendues ou non, et de problématiques spécifiques émergent, justifiant une consommation de soins grandissante. Le besoin d’études en population a motivé l’analyse secondaire de données médico-administratives dans diverses régions du globe. L’objectif de cette thèse était d’étudier les conditions d’utilisation des bases de données médico-administratives (BDMA) et leurs applications possibles pour mieux comprendre les enjeux émergents de cette population nouvelle d’adultes avec CC (ACC). La première partie de ce travail a été de décrire de manière systématique toutes les études ayant utilisé des BDMA pour explorer spécifiquement les problématiques des patients ACC. Cette revue a montré l’intérêt de ces bases de données dans le domaine des ACC, les effectifs importants permettant d’étudier des maladies relativement rares et la disponibilité de données exhaustives sur de longues périodes d’observation autorisant l’étude de certaines complications cardiaques ou extracardiaques de survenue parfois différée chez ces patients. En France, les bases de données administratives de remboursement utilisent la Classification internationale des Maladies, dixième révision (CIM-10) dont la fiabilité pour repérer les ACC et les pathologies qui leur sont associées est inconnue dans ce contexte. La deuxième partie de ce travail avait donc pour objectif d’étudier la performance de la CIM-10 pour identifier et classer des patients ACC au sein de l’entrepôt de données de l’hôpital Européen Georges Pompidou disposant d'une unité dédiée aux ACC. La troisième partie de cette thèse rapporte un exemple concret de l’utilisation des BDMA. A partir des données de la Québec Congenital Heart Disease Database issue des BDMA du Québec, notre objectif était d’évaluer l’association entre l’exposition aux rayonnements ionisants provenant de procédures cardiaques et la survenue de cancer chez les ACC. En effet, l’amélioration de l’espérance de vie des patients avec CC et l’augmentation du recours aux modalités d’imagerie cardiaque irradiante, font craindre un effet carcinogène potentiel à long terme. Bien qu’elles n’aient pas été conçues à des fins de recherche, ce travail de thèse montre que les BDMA sont un outil particulièrement pertinent pour générer de nouvelles connaissances sur les patients ACC de par l’exhaustivité des informations disponibles, la possibilité de produire de grands échantillons et de permettre un suivi longitudinal sur de longues périodes d'observation. L’exploitation des dossiers médicaux électroniques par des méthodes de fouilles de texte pourrait alors permettre de développer et valider des algorithmes pour identifier les cas de CC dans les BDMA. En France, bien que des efforts aient été déployés pour créer un programme de collaboration multicentrique efficace, il n’existe à l’heure actuelle aucune donnée épidémiologique d’envergure concernant l’ensemble des ACC. L’analyse secondaire de ressources existantes, telles que le Système National des Données de Santé, permettrait d’établir la cohorte nationale d’ACC et d’analyser leur parcours de soins afin d’orienter au mieux l’allocation des ressourcesCongenital heart diseases (CHD) are the most common types of birth defects and affect approximately 1% of births. Ninety percent of children born with CHD reach now adulthood thanks to improvements of pediatric cardiology and cardiac surgery. These "survivors" are not definitively cured. They are prone to cardiac or extra cardiac complications and specific issues that justify an increase in consumption of healthcare. The need for population-based studies worldwide has led to secondary analyses of administrative medical databases (AMD). The objective of this thesis was to study the conditions of use of the AMD and their possible applications, specifically to understand the emerging issues of this new adult population with CHD (ACHD). The first part of this work was to systematically describe all the studies that had used AMD to specifically explore the issues of ACHD patients. This review showed the value of these databases in the field of ACHD: the large numbers of patients allows studying relatively rare diseases and the availability of comprehensive data over long periods of follow-up enables to study cardiac and extra cardiac complications even when the occurrence is delayed. In France, claim databases use the International Classification of Diseases, 10th revision (ICD-10), the reliability of which is still largely unknown in this context. The second part of this work was therefore to study the performances of ICD-10 to identify and classify ACHD patients in the data warehouse of the Georges Pompidou European Hospital which has a dedicated specialized ACHD Unit. The third part of this thesis reported a concrete example of the use of AMD. Based on the Quebec Congenital Heart Disease Database derived from Quebec’s AMD, our goal was to evaluate the association between exposure to ionizing radiation from cardiac procedures and the risk of cancer in ACHD. Indeed, the improvement in the life expectancy of patients with CHD and the increasing use of cardiac imaging modalities using ionizing radiations may have a carcinogenic effect in the long term. Although not designed for research purposes, this thesis showed that AMD are a particularly relevant tool for generating new knowledge about ACHD patients through the comprehensiveness of information, the possibility of extracting large samples of patients with a longitudinal follow-up over long periods of observation. The exploitation of electronic medical records through text mining methods could then be used to develop and validate algorithms to identify CHD patients in AMD. In France, although efforts have been made to create an effective multi-center collaborative program, there is currently no significant epidemiological data for all ACHDs. Secondary analysis of existing resources, such as the National Health Data System, would establish the national ACHD cohort and analyze their care pathway in order to guide healthcare resources allocation
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von, Wenckstern Michael. "Web applications using the Google Web Toolkit." Master's thesis, Technische Universitaet Bergakademie Freiberg Universitaetsbibliothek "Georgius Agricola", 2013. http://nbn-resolving.de/urn:nbn:de:bsz:105-qucosa-115009.
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This diploma thesis describes how to create or convert traditional Java programs to desktop-like rich internet applications with the Google Web Toolkit. The Google Web Toolkit is an open source development environment, which translates Java code to browser and device independent HTML and JavaScript. Most of the GWT framework parts, including the Java to JavaScript compiler as well as important security issues of websites will be introduced. The famous Agricola board game will be implemented in the Model-View-Presenter pattern to show that complex user interfaces can be created with the Google Web Toolkit. The Google Web Toolkit framework will be compared with the JavaServer Faces one to find out which toolkit is the right one for the next web projectDiese Diplomarbeit beschreibt die Erzeugung desktopähnlicher Anwendungen mit dem Google Web Toolkit und die Umwandlung klassischer Java-Programme in diese. Das Google Web Toolkit ist eine Open-Source-Entwicklungsumgebung, die Java-Code in browserunabhängiges als auch in geräteübergreifendes HTML und JavaScript übersetzt. Vorgestellt wird der Großteil des GWT Frameworks inklusive des Java zu JavaScript-Compilers sowie wichtige Sicherheitsaspekte von Internetseiten. Um zu zeigen, dass auch komplizierte graphische Oberflächen mit dem Google Web Toolkit erzeugt werden können, wird das bekannte Brettspiel Agricola mittels Model-View-Presenter Designmuster implementiert. Zur Ermittlung der richtigen Technologie für das nächste Webprojekt findet ein Vergleich zwischen dem Google Web Toolkit und JavaServer Faces statt
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Kostylova, Alla. "Concordance between childhood injury diagnoses from an injury surveillance system and a physician billing claims database." Thèse, 2005. http://hdl.handle.net/1866/17642.
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Yang, Min. "Antipsychotic drug utilization patterns and treatment-emergent diabetes: a methodological comparison of incidence using a claims database." Thesis, 2006. http://hdl.handle.net/2152/2648.
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Van, Rensburg Hendrika Nicolien Janse. "A longitudinal study of the usage of acid reducing medicine using a medicine claims database / H.N. Janse van Rensburg." Thesis, 2007. http://hdl.handle.net/10394/1903.
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Lee, Eric Kin-Lap, and 李建立. "Evaluation of the Ambulatory Care Costs and Drug Utilization of the Post-Renal Transplant Patients with the Taiwan NHI Claims Database." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/14137018857130455638.
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博士高雄醫學大學
藥學研究所
99
OBJECTIVES： Owing to the first-year ambulatory cost after transplantation generally considered as an indicator of the success of the transplantation surgery, in this thesis we attempted to evaluate the ambulatory care costs and drug utilization of the post-renal transplant patients with the Taiwan NHI claimed database. Firstly we proposed to conduct a pharmacoepidemiology study to examine the utilization and the expenditure for immunosuppressants among renal transplant recipients in order to estimate the growth of future costs under the Taiwan global budget system. Secondly, we will compare the total expenditure of the first year post-transplantation ambulatory health care and drugs used that attempted to provide evidence that the renal transplantation was less costly than hemodialysis. Lastly, we hope to evaluate the differences of the ambulatory health care costs and drug utilization of the first year post-renal transplantation between the patients who have had domestic and foreign renal transplant surgery. STUDY MATERIALS & DATA MANAGEMENT： For the study data, we used the Taiwan Longitudinal Health Insurance Database (2005), which contained all of the claims data from 1,000,000 beneficiaries who were randomly sampled from the Registry for Beneficiaries of the National Health Insurance Research Database, which includes approximately 25.68 million individuals, namely, 98% of the population in Taiwan. This database contains all the ambulatory, emergency, and hospitalization claims information and costs tracked back to 1997 and carried to 2006. All of the NHRI data were delivered as text files and the SPSS Chinese version 13.0 statistical program was used to transcribe them into working files for further analysis. MAJOR FINDINGS： The first-year post-transplantation drug costs and total health care costs of the kidney, heart, lung, liver, and other organ transplantations were evaluated and the drug expenditures were about 80% of the total health care cost except for the other specified organ transplant, i.e., bone marrow, wherein they were 60%. The mean differences between drug expenditures and total costs of various organ transplants were significant differences (p<.01; ANOVA). Compared with the first period covering 1999–2003, wherein the most frequently prescribed immunosuppressive agents were cyclosporine (43%), mycophenolate (30.8%), and tacrolimus (21.3%), the updated information showed cyclosporine (36.8%), tacrolimus (30.17%), and mycophenolate (21.46%). In 2005, the total drug expenditure for tacrolimus was higher than for cyclosporine which was the major immunosuppressive agent used previously. There was a significant difference between the age group of the foreign renal transplant surgery cases (44.44±13.11) and the domestic cases age (39.43±9.19) with (p=0.012) using the independent T-TESTS. The estimated first year post-renal transplantation ambulatory drug costs and total costs of the domestic renal transplant surgery cases were significantly higher than the foreign cases (p=0.005 and p=0.004) respectively. However, there was no significant differences for the drug of choice used initially from the first-year after renal transplant surgeries (p=0.495).
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Lo, Thomas King Tong. "Using population health data to measure healthcare costs of arthritis for Australian women." Thesis, 2015. http://hdl.handle.net/1959.13/1063100.
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Research Doctorate - Doctor of Philosophy (PhD)Objective: The aims of this thesis were to: 1) to systematically examine the methods for identifying individuals with arthritis; 2) and systematically examine the methods for estimating healthcare cost using individual-level data; 3) using these valid methods to calculate the healthcare cost of arthritis in older Australian women with arthritis; 4) examine the past trends of the healthcare cost; and 5) analyse the explanatory factors of the healthcare cost of arthritis. Methods: The thesis was grouped into two parts. Each part consists of three independent studies using different study methods. In Part One, various case-definitions of arthritis using population-based data were examined in detail. The studies include a systematic review of published prevalence studies and two other studies designed to assess the performance of two different case-definitions of arthritis. Part Two consists of a systematic review of published cost of arthritis studies that identify the most appropriate measurement methods for the cost of arthritis, followed by two other studies that apply the these methods (with the best arthritis case-definition identified from Part One) to estimate the healthcare cost of arthritis and to assess the explanatory factors for cost. The studies were based on data for participants in the Australian Longitudinal Study on Women’s Health. The healthcare utilisation and cost information were obtained from the linked Medicare Australia datasets. Results: In Part One, the systematic review found that self-reported arthritis was the most common case-definition in recent prevalence of arthritis studies. Examination of the agreement between self-reported diagnosed arthritis and musculoskeletal symptoms found that there was adequate agreement between these two measures. Utility of healthcare administrative data for identification of arthritis was also explored by means of case identification algorithms systematically built using elements from Medicare data. The algorithms were found to have no better than fair agreement with self-reported arthritis. Overall, results indicate that self-reported diagnosed arthritis is the best option for a case-definition to study the economic burden of arthritis in the Australian context. In Part Two, the results from the systematic review indicated that the incremental cost method is most appropriate for accounting for the costs of comorbidities in individuals with arthritis. Results also indicated that gamma regression and quantile regression statistical methods should be adopted in the cost of arthritis studies in this thesis. Accordingly, the mean adjusted incremental Medicare cost among older Australian women with arthritis was estimated at (AUD 2012) $502.59 per person per year in 2009. Results also indicate that the cost of comorbidities accounts for a considerable proportion of the Medicare costs. Cost distribution was severely positively skewed (as illustrated by the estimates at several percentiles), where the top 10% of the population incurred 300% greater costs. Longitudinal analysis did not find significant changes in arthritis costs between 2003 and 2009. Results also show that explanatory variables had statistically significantly different effects on healthcare cost at different percentiles of cost. Specifically, quantile regression found that for each increase in the SF-36 physical component score (PCS), Medicare cost decreased by $47, $71, $137, and $195 at the 50th, 75th, 90th, and 95th percentiles respectively. And for each increase in the number of comorbid conditions, Medicare cost increased by $195, $200, $419, and $639 at the 50th, 75th, 90th, and 95th percentiles respectively. Moreover, generalized estimating equations predict thatneed variables (such as the SF-36 PCS score and the number of comorbid conditions) have less influence on cost than do predisposing characteristics (such as area of residence), and enabling factors (such as complementary health insurance coverage). Conclusion: This thesis makes a substantial contributions in three main areas. First, it provides robust evidence to show that self-reported diagnosed arthritis is the best case-definition option for population-based epidemiological studies. Second, this thesis extends our understanding of the healthcare cost of arthritis by employing advanced methods in cost research. It was possibly the first study in Australia that assessed the cost of arthritis (all forms combined) using individual-level data, and the incremental cost method to account for the impact of comorbidity on the cost of arthritis. An assessment of the cost trends over time using longitudinal data also provides insights into the dynamics of the healthcare cost of arthritis. Third, this thesis sets new directions and methods for future research on the determinants of healthcare cost. It provides evidence that individuals with different levels of healthcare utilisation are heterogeneous groups, and that their healthcare costs are influenced by different sets of explanatory factors at different degrees between these sub-groups. It also provides evidence that traditional regression methods, which produce a single rate of change (a slope) as indicated by the regression coefficient, are incapable of accurately describing the relationships between the explanatory variable and costs across the entire cost distribution. Moreover, it demonstrates that quantile regression is a very useful tool, not only in the estimation of the adjusted cost of arthritis at multiple percentiles, but also in the assessment of the explanatory factors of cost in population sub-groups. The findings of this thesis lead to a more accurate understanding of the economic burden of arthritis and provide important insights into the determinants of healthcare costs in Australians with arthritis.
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Agyakwa, Winifred Esther. "Antibiotic usage in South Africa: a longitudinal analysis of medicine claims data / Winifred Esther Agyakwa." Thesis, 2014. http://hdl.handle.net/10394/14109.
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The main aim of the study was to determine the prescribing patterns of antibiotics with an emphasis on fluoroquinolones in the private health sector of South Africa. The empirical study followed a quantitative, descriptive, observational method using retrospective, longitudinal medicine claims data provided by a nationally representative Pharmaceutical Benefit Management company (PBM) from 1 January 2005 to 31 December 2012. Penicillins, cephalosporins, carbapenems, aminoglycosides, chloramphenicol, fluoroquinolones, macrolides, tetracyclines, sulphonamides and trimethoprim were considered in the study.
A total of 5 155 262 (44.8%) patients received at least one antibiotic prescription out of the total number of registered beneficiaries included in the database. The average number of antibiotic prescriptions per patient per year ranged from 2.22 ± 1.89 (95% CI 2.22-2.22) in 2005 to 1.98 ± 1.62 (95% CI 1.98-1.99) in 2012. The number of antibiotics per prescription per year remained fairly constant at 1.05 ± 0.19 (95% CI 1.05-1.05) in 2005 to 1.06 ± 0.21 (95% CI 1.06-1.06) in 2012. The prevalence of patients receiving antibiotic prescriptions decreased from 46.1% (n = 789 247) in 2005 to 38.2% (n = 480 159) in 2012. Antibiotics were mostly prescribed for females (54.9%, n = 2 831 686) and in patients aged 0 to 18 years (26.5%, n = 1 366 824) and least in patients above 65 years (9.5%, n = 490 496). The prevalence of patients receiving antibiotic prescriptions was highest in Gauteng (41.9%, n = 2 159 360) and lowest in the Northern Cape (1.7%, n = 87 720). Antibiotics were mostly prescribed during the winter period. Penicillins were the most prescribed antibiotics (43%) and carbapenem the least (0.1%) out of the total number of antibiotics claimed. No practically significant association was found between antibiotic prescribing and gender, age, province and season.
A total of 1 983 622 prescriptions for fluoroquinolones were claimed in patients older than 18 years. The average number of fluoroquinolone prescriptions per patient per year ranged from 1.45 ± 0.92 (95% CI 1.44-1.45) in 2005 to 1.31 ± 0.71 (95% CI 1.31-1.32) in 2012. The highest prevalence of fluoroquinolone prescribing was observed in females (64.1%, n = 850 253) and in patients between 45 and 65 years (38.6%, n = 511 542). The total fluoroquinolone use by the study population decreased from 2.85 DID in 2005 to 2.41 DID in 2012. Norfloxacin was the only first-generation fluoroquinolone prescribed. The second-generation fluoroquinolones accounted for more than 50% of the total DID, with ciprofloxacin being the most used active ingredient in this generation. Moxifloxacin was the most prescribed third-generation fluoroquinolone; its use ranging from 0.51 DID in 2005 to 0.44 DID in 2012. Between 2005 and 2012, a total of 57 325 prescriptions for fluoroquinolones were claimed by patients 18 years and younger. The prevalence of patients receiving fluoroquinolone prescriptions decreased from 3.6% (n = 8 329) in 2005 to 2.9% (n = 3 310) in 2012. Fluoroquinolones were mostly prescribed to females and in patients between 12 and 18 years. In all age groups, prescribing was mainly done by general medical practitioners. Ciprofloxacin was the most prescribed fluoroquinolone, followed by levofloxacin.
In conclusion, this study established estimates on the prevalence of antibiotic prescribing covering an eight-year period. Secondly, baseline estimates for fluoroquinolone prescribing in adults using the ATC/DDD methodology were determined. Fluoroquinolone prescribing patterns in children and adolescents were determined, with specific reference to the comparison between the prescribed daily and recommended daily dosages in the different age groups and by prescribers’ specialties.MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015
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黃清發. "The utilitation of Health Insurance Resources for the Septermber 21 Earthquake refugees--Analysis of the Central Bramch Claims database of the bureau of National Health Insurance." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/92731691635150166929.
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碩士中國醫藥學院
醫務管理研究所
89
The September 21 earthquake has made an enormous impact on the system of medical resources and services in Taiwan. One major task of the government after the 1999 Chi-Chi earthquake was to fulfill the medical needs of the afflicted population. This study utilize claim data files from Bureau of National Health Insurance to investigate the changes and impact of 921 earthquake on healthcare organizations in central Taiwan by hospital accreditation level, hospital location, and patient age groups. This study evaluated and analyzed the medical services utilization patterns of the residents in the afflicted regions before and after the earthquake. This study analyzes and compares the use of health insurance resources in central Taiwan before and after the September 21 earthquake. By a perusal of relevant records, it was found that the emergency medical care measures adopted by the Bureau of National Health Insurance after the September 21 earthquake had enabled victims of the quake to obtain immediate and efficient medical treatment. This study also analyzes refugees with uremia as well as case study of risk management of these hospitals'' located in disaster area. The results indicated that both outpatient and services utilizations among the afflicted population had increased dramatically. The utilizations of western medicine after the earthquake had been raised. The overall ambulatory visits increased by 36.66%, the growth rate of total medical expenditure was 26.63%. For clinics and local hospital the number of ambulatory visit increased by 40.47%, for regional hospitals the number of visits decreased by 1.97%, and for the medical centers the visits increased by 17.62%. For patient age group analysis, the group with age below 12 has the highest grow rate of 47.26% in terms of ambulatory visits. The growth rate of medical expenditure increased by 33.87%, decreased by 8.50%, and increased by 19.21%, respectively. The overall ambulatory visits increased, for clinics and local hospitals the number of visits is greater than regional hospitals and regional hospitals visits is greater medical centers. For patient age group analysis, the group with below 12 has the highest grow rate 0f 47.26% in terms of ambulatory visits. The Analysis of refugees with uremia the overall ambulatory visits increased by 4.91%. For disaster areas the number of ambulatory visit increased by 13.49%, for non-disaster areas the number of ambulatory visits increased by 2.47%. Risk Management of six hospitals. After paying visits to hospitals located in the disaster areas, it was also found that these hospitals had all taken proper and efficient measures in the situation of emergency caused by the tremor. Although the earthquake damaged the medical equipment of the hospitals and cut off all electric powers and telephone communication, the staff members of the hospitals still managed to move inpatients to safer places and make emergency rescue. Those in charge of these hospitals also made suggestions to relevant authorities regarding how to improve the satellite communication system of the medical network, make more efficient use of helicopters to transport patients, and arrange for their inpatients to receive medical treatment at other hospitals. A lot of efforts were made to improve our emergency medical care system in the hope that the health of our nationals can be insured in the future. The study demonstrated the effectiveness of the health service programs offered by the government after the earthquake, which successfully increased the utilization of medical services among the afflicted population and satisfied their medical needs. Hospitals need to develop plans and routine practice for earthquake risk management. A lot of efforts were made to improve our emergency medical care system in the hope that the health of our people can be insured in the future.
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Lu, Chun-Hui, and 呂春輝. "Five-Year Claim Database Analysis of Asthma in Taiwan." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/36999288579440428751.
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碩士國防醫學院
藥學研究所
93
The National Health Insurance (NHI) program was officially launched on March 1th, 1995, in Taiwan for ten years. The balance of revenues and expenditure was stable initially, but a deficit was shown since 1998. Health-related retrospective databases, in particular claims databases, continue to be an important data source for outcomes research. Our study analyzes the results from consecutive claimed-database to obtain medical resource utilization as it occurs in routine clinical care, and to discuss the rationality of medical resource utilization. The results can also provide evidences to decision makers to make rational decision on strategies to execute disease management, and apply to pharmacoeconomic evaluations. Objectives: (1) To compare the asthma prevalence from the consecutive claimed-database to published results. (2) To understand trends of medical resources utilization of asthma in Taiwan. (3) To understand the improvement of asthmatic care in Taiwan. Methods: During the year 1998 to 2002, claims with primary and secondary diagnosis of asthma in their ICD-9-CM code and A-code were obtained and then sorted per person to obtain their whole medical resource utilization. Those data files included ambulatory care expenditures by visits, details of ambulatory care orders, inpatient expenditures by admissions and details of inpatient orders. The STATA 8.0 and SAS 8.2 computer softwares were used to perform the analysis. Results：(1) The prevalence of asthmatic patients form 1998 to 2002, from primary diagnosis, was 8.84%, 3.48%, 2.24%, 2.20% and 2.15%, respectively. (2)Number of Outpatient visited per person per year was from 2.07(1998) to 3.17(2002). Average prescription days per person: from 7.25(1998) to 12.08(2002). Number of hospitalization per person per year: from 0.02(1998) to 0.07(2002). Number of emergency visited per person per year: from 0.05(1998) to 0.14(2002). (3)Total cost per year: NT$ 3.2, 2.3, 1.9, 2.0 and 2.2 billion dollars. (4) The ratio of drug costs/total costs about 45%. Conclusions: Condition of asthmatic outpatient care was improving and inpatient care was worsen. The ratio of drug costs plays an important role in asthmatic care.
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Costa, André Luís Rocha da Silva. "Quality costs analysis: case study in the automotive industry." Master's thesis, 2015. http://hdl.handle.net/1822/39287.
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Dissertação de mestrado integrado em Engenharia e Gestão IndustrialThe main goal of this Project was to analyze with resource to Quality Tools the Current Warranty Process and the Warranty Claims since 2012 until the First Quarter of 2015, in order to recover from Supplier the Quality Costs regarding defective materials. This dissertation was developed in the Automotive Industry in Delphi Automotive Systems Portugal S.A. Currently, the Quality Costs regarding each Warranty Claim are unknown by Delphi, setting a fixed value of 1000 € for each Warranty issue, that is not valid at Supplier’s eyes, considering it does not reflect the real costs of each claim and it is much higher than the price that Delphi paid for each component. Although, Delphi has a Zero Defects Policy and did not pay for No Quality regarding defective components, is being charged by Customer. Delphi Braga wants to be the first company in Delphi group to recover Quality Costs from every Supplier, in order to raise awareness and to ensure that every Supplier is committed to Delphi Policy and to minimize the current Quality Costs. According to the Literature, one of the principles of Quality Continuous Improvement is based on the assumption that every decision, in special those which are taken by Quality Team, should rely on the use of Quality Tools, for the purpose to discover the critical root causes to be solved and to implement corrective actions, ensuring the Quality Standards. The higher is the short-term investment in Costs of Good Quality as Prevention and Appraisal Costs, the less are the long-term costs of Poor Quality throughout the Supply Chain as Internal and External Failure Costs, ensuring a win-win strategy for all stakeholders and nurturing business partnership towards Delphi requirements of being known among Customers as their best Supplier, surpassing their highest expectations. A rigorous analysis was undertaken to 7696 Warranty Claims from 2012 until the First Quarter of 2015, concluding that there are 153 complaints confirmed by supplier analysis as defective material corresponding to a total of 80.724.31€. Given that, the Quality Costs were associated to each Warranty Claim, creating a cost-oriented Database with all the Customer Debit Costs per device and when added to the Analysis Costs, the amount that Delphi has to recover from Supplier was calculated.
O objetivo principal deste projeto é a análise, com recurso às Ferramenta da Qualidade, do Atual Processo de Garantia e das Reclamações ao abrigo da Garantia desde 2012 até ao 1º Quadrimestre de 2015, para recuperar Custos de Qualidade junto do fornecedor relativos a defeitos de material. Esta dissertação foi desenvolvida na Indústria Automóvel na Delphi Automotive Systems Portugal S.A. Atualmente, os Custos da Qualidade relativos a cada Reclamação de Garantia não são conhecidos pela Delphi, tendo-se fixado um valor de 1000 € para cada defeito de Garantia, o que não é válido do ponto de vista do fornecedor, uma vez que não reflete os custos reais de cada reclamação e é muito superior ao preço que a Delphi paga por componente fornecido. Embora a Delphi tenha uma Política de Zero Defeitos e não paga por componentes fornecidos defeituosos, tem de pagar ao Cliente. A Delphi Braga quer ser a primeira empresa no grupo Delphi a recuperar Custos de Qualidade de todos os Fornecedores, de forma a consciencializar e a assegurar que cada Fornecedor está comprometido com a Política da Delphi para minimizar os atuais Custos de Qualidade. De acordo com a Literatura, um dos princípios da Melhoria Contínua da Qualidade é baseado no pressuposto de que todas as decisões, em especial aquelas que são tomadas pela Equipa de Qualidade, devem depender das Ferramentas da Qualidade com o propósito de descobrir as causas-raiz críticas a serem resolvidas e as medidas corretivas a serem implementadas, garantindo os Padrões de Qualidade. Quanto maior for o investimento a curto-prazo em Custos de Boa Qualidade, menor são os custos a longo-prazo da Má Qualidade ao longo da cadeia de abastecimento, assegurando uma estratégia mutuamente benéfica para todos os intervenientes e alimentando parcerias comerciais, tendo em vista os requisitos da Delphi, de ser conhecida entre os seus clientes como o seu melhor fornecedor, superando as suas maiores expectativas. Foi realizada uma análise a 7696 Reclamações de Garantia desde 2012 até 1ºQuadrimestre de 2015, concluindo que existem 153 reclamações confirmadas pelo Fornecedor, como sendo defeitos de material, correspondendo a um total de 80.724.31€. De forma a materializar este valor, os Custos da Qualidade foram associados a cada Reclamação de Garantia, criando uma base de dados orientada aos custos, onde são apresentados todos os Custos Debitados pelo Cliente por aparelho e quando somados aos Custos de Análise, é obtido o valor que a Delphi deve recuperar.
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Murtazashvili, Ilia. "The political economy of claim clubs : squatters, presumptive rights, and the origins of legal title on the American frontier /." 2009. http://www.library.wisc.edu/databases/connect/dissertations.html.
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Pratt, Nicole. "Medication prescribing in the elderly and the effect on health related outcomes: an investigation of bias in observational studies using computerised claims databases." Thesis, 2010. http://hdl.handle.net/2440/63634.
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Background: This thesis explores the effects of medication prescribing on patient outcomes in an ageing population, specifically, the population of Australian veterans. The primary source of data is the computerised administrative claims database maintained by the Commonwealth Department of Veterans' Affairs. This database is a valuable resource yet knowledge about how these data can be analysed and interpreted to study the effects of medicine use in the Australian setting is limited. An important source of bias in observational studies relating medication prescribing to health outcomes arises from confounding by the reason for prescription, or confounding by indication. The extent to which traditional pharmacoepidemiological studies utilising administrative claims databases can deal with confounding is limited as these data sources often lack information on many potentially important confounders, such as clinical information, life style factors and disease severity.
Aim: The aim of this thesis was to investigate the use of two methods, developed to overcome possible bias in observational studies due to unmeasured confounding; instrumental variable analysis and the self-controlled case-series design. To illustrate how these techniques may be used to overcome confounding, I investigate how they apply to the assessment of the adverse effects of antipsychotic prescribing in the elderly.
Methods: The instrumental variable analysis was used to compare the risk of death, hip fracture and pneumonia between the antipsychotic classes. The instrumental variable analysis aims to control for unmeasured confounding by attempting to mimic the process of random assignment in a randomised controlled trial. The self-controlled case-series design was used to investigate the risk of hospitalisation for stroke, hip fracture and pneumonia associated with antipsychotic initiation. The self-controlled case-series design uses a patient as their own control, thereby implicitly controlling for constant patient specific confounders, even those that are unmeasured.
Results: Using a cohort of 20,205 elderly patients aged over 65 years of age, I have shown that the profiles of patients receiving antipsychotic medicines vary between the class of antipsychotic initiated and those variables that differ are likely to be associated with the reported adverse events of these medicines. This indicates the potential for confounding in observational studies of antipsychotics and suggests that appropriate study designs are required to minimise the effect of confounding in order to get a clear understanding of the potential adverse events of these medicines.
The instrumental variable analysis suggested that typical antipsychotics were associated with an extra 24 (95% confidence interval (CI) 18-30) deaths per 100 patients per year compared to atypical antipsychotics, and an extra 10 (95% CI 7-14) deaths per 100 patients per year among nursing home residents. In this analysis I proposed a new instrument, facility prescribing preference, as an alternative to the doctor prescribing preference instrument; the latter which has been used extensively in the pharmacoepidemiological literature. I was able to show that facility preference may be a valid instrument for further work in this area as it was highly correlated with actual treatment (Odds Ratio 19.2; 95% CI 17.1-21.6), provided a good balance of measured patient characteristics and was consistently strong over time.
While the instrumental variable analysis can provide information regarding the comparative risk of antipsychotics between the classes it cannot inform about the individual risk of these medicines compared to no treatment. To answer this question I used the self-controlled case-series design to estimate the excess risk of hospitalisation for stroke, hip fracture and pneumonia after initiation of an antipsychotic. Atypical antipsychotics were not associated with an increased risk of stroke, which is consistent with randomised controlled trial evidence. No such evidence is available for typical antipsychotics in the elderly, however, the case-series analysis suggests that there is a small but significantly increased risk of hospitalisation for stroke in the first week after initiation (Incidence Rate Ratio (IRR); 2.1, 95% CI 1.1-4.2). For pneumonia the risk was raised in all periods after antipsychotic initiation. This risk was highest in the first week after initiation and remained significantly raised by 50% with more than 12 weeks of treatment (Typical antipsychotics IRR; 1.5, 95% CI 1.2-1.9, Atypical antipsychotics IRR; 1.5, 95% CI 1.3-1.7). The risk of hip fracture was significantly increased for both classes but this risk was sustained only with long-term typical antispychotic use (IRR; 1.3, 95% CI 1.1-1.6).
The self-controlled case-series design has been used extensively in the investigation of vaccine safety. I have found, however, that the application of this design to the study of the effects of medicine prescribing in the elderly may require the addition of an unexposed group to control for the increasing incidence of hospitalisation with age in this population. I also explored the use of risk periods prior to initiating therapy with antipsychotics. Patients were more likely to have had a hospitalisation for stroke in the week prior to initiating typical antipsychotics (IRR; 6.9, 95% CI 4.7-10.0) while atypical antipsychotic initiators had no excess risk in the same period (IRR; 1.2, 95% CI 0.5-2.6). These results suggest that the use of pre-exposure risk periods may be required in medicine outcome studies when the outcome of interest is a hospitalisation event that leads to an increased likelihood of initiating treatment.
Conclusion: This thesis has illustrated that identifying and reducing confounding will enhance the validity of observational studies investigating the safety of medicines using computerised claims databases. By employing methods that help to overcome the problem of confounding I was able to demonstrate that antipsychotic use in the elderly is associated with significant harm and the increasing use of these medicines in Australia poses a major public health concern. Randomised controlled trial evidence suggests that for every 100 patients treated with atypical antipsychotics over 12 weeks, only 8 to 33 would show any benefit, however, there would be 1 additional death and 2 additional cerebrovascular events. Using the self-controlled case-series design I estimated that there would be 8 additional pneumonias, and 2.5 additional hip fractures for every 100 patients treated with atypical antipsychotics over 12 weeks. In addition, typical antispychotics were found to be associated with at least equivalent, if not more, harm. The knowledge obtained in this thesis will help to inform how Australian computerised claims databases may be interrogated to examine the safety of medicines that are under investigated in randomised controlled trials. This information will allow prescribers and policy makers to make more informed decisions about the risks of medicines.Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2010