Anonymous Record Research Articles

Women's choice? The impact of private health insurance on episiotomy rates in Australian hospitals

Objective: to assess the extent to which variations in episiotomy rates in Australian hospitals are justified by clinical variables and to further explore the relationships between episiotomy, insurance status, perineal trauma and outcomes for babies.Design: a retrospective analysis of anonymous medical record data using logistic regression models, aimed at identifying factors influencing both episiotomy rates and outcomes for babies.Setting: a large regional public hospital, New South Wales, Australia.Participants: the study sample consisted of 2028 women who delivered vaginally during a 12 month period during 1996–1997.Results: after controlling for clinical and other factors privately insured women were estimated to be up to twice as likely to experience episiotomy as publicly insured women. This difference most plausibly reflects differences in labour management styles between obstetricians and midwives. Other significant contributors to episiotomy were instrumental delivery, indications of possible fetal distress and lower parity. Severe perineal trauma (third degree tear) was found to be positively associated with episiotomy. Furthermore, the incidence of additional tears requiring suture was also substantially higher among privately insured women, the net effect being that these women had a substantially lower chance of achieving an intact perineum. Neither episiotomy nor insurance status had any significant effect on the well-being of babies.Implications for practice: private health insurance appears to deny many women the opportunity of achieving normal vaginal delivery with intact perineum. Episiotomy rates amongst privately insured women in Australia may be higher than is clinically appropriate, and severe perineal trauma within this study was associated with this practice.

How to ensure data security of an epidemiological follow-up:quality assessment of an anonymous record linkage procedure

A computerised record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the standard hash algorithm (SHA) function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks, two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by means of a statistical model, taking into account several identification variables. Quality assessment of this anonymous record linkage procedure shows a specificity of 100% and a sensitivity of 95%.

Residential Movement into Elderly Person Households: Evidence from the 1991 Household Sample of Anonymised Records

In this paper we use data from the 1% British Household Sample of Anonymised Records (SAR) to examine coresident households which have been formed by the movement of people under the age of sixty five into the homes of elderly people. The SAR does not give information on why such moves have taken place. However, an examination of the characteristics of the movers and their elderly receivers, and the relationships between the two, sheds some light on the issue. Analysis shows that most movement into the homes of elderly people is by people who are related to them—mainly their children and their children's partners and/or children. It is often assumed that coresidence between elderly people and their younger relatives is driven by the care needs of the older generation. However, in this paper we cast doubt on this simple assumption, arguing that it is equally necessary to look at the characteristics and circumstances of movers in order to understand coresidence in the elderly households under examination.

Migration of Elderly People to Join Existing Households: Some Evidence from the 1991 Household Sample of Anonymised Records

"In this paper the extent to which migration of the elderly is linked to changing family living situations [in Great Britain] is explored.... [The authors] estimate the number of older people making moves of this type, and...identify their age, sex, and marital status, and their relationship to the household they have joined. It is also possible to say something about the households which these people are joining, in terms of tenure and house type, and to describe the distribution of distances moved."

Evaluating the quality of anonymous record linkage using deterministic procedures with the New York State AIDS registry and a hospital discharge file.

Linkage of same-person records across multiple databases relies on high-quality, uniformly available identifying information. These data quality issues become increasingly important when personal names are not available for record linkage. Using deterministic decision criteria, we linked records from two population-based files in the absence of personal names. The sensitivity of anonymous record linkage procedures ranged from 32 to 85 per cent for the two years studied, and the positive predictive value (PPV) ranged from 14 to 99 per cent. Decreasing sensitivity and PPV were primarily attributed to (1) errors in computerized identifying information and (2) the deterministic decision criteria specified for record linkage. An evaluation of the contribution of personal names to the quality of record linkage found no measurable impact.

Putting the 1991 census sample of anonymised records on your Unix workstation.

"The authors describe the development of a customised computer software package for easing the analysis of the U.K. 1991 Sample of Anonymised Records. The resulting USAR [Unix Sample of Anonymised Records] package is designed to be portable within the Unix environment. It offers a number of features such as interactive table design, intelligent data interpretation, and fuzzy query. An example of SAR analysis is provided."

Mortality associated with surgery: a case review study

The review is based on an analysis of anonymous case record material at the London Office of a United Kingdom medical protection organisation for the 5-year period 1982-1986, in which death was associated with general surgical procedures. A total of 16 cases were analysed. The majority of deaths occurred in the course of elective procedures, the patients were relatively young (average age 48.4 years) and the doctors involved were primarily of consultant grade. While the types of procedure and the proximate causes of death were varied there were a number of common factors contributing to patient deaths, principally inadequate pre-operative assessment (4 cases), inadequate post-operative management (3 cases) and lack of experience with particular surgical procedures (3 cases). The results are discussed in terms of their relation to the findings of the National Confidential Inquiry into Perioperative Deaths. Suggestions are made concerning training, communication and the introduction of critical incident monitoring into surgical practice.

Mortality associated with anaesthesia

The review is based on an analysis of anonymous case record material at the Medical Protection Society's London Office for the 5-year period 1982-1986, in which death was associated with anaesthetic procedures. A total of 25 cases were analysed. The principal events which resulted in death were failed intubation, drug-related problems and problems with equipment. The principal contributory factors were inadequate supervision, inadequate pre-operative assessment and failure of communication. The present review suggests that supervision and training of junior staff, decision-making by senior staff and patterns of communication both within and between specialties are areas which should be selected for further research.

An algorithm for matching anonymous hospital discharge records used in occupational disease surveillance: Anonymous record matching algorithm

The expense of collecting primary data, coupled with limited authority to mandate reporting, requires alternative methods of implementing an occupational disease registry in Illinois. One alternative data source for surveillance of some occupational diseases is hospital discharge records. Because these records lack personal identifiers, it has been impossible historically to match records belonging to the same individual and obtain reliable case estimates. To circumvent this difficulty, an algorithm has been developed to match anonymous hospital discharge records collected from all Illinois hospitals. The algorithm was based on the assumption that specific combinations of occupational disease code, sex, zip code, and date of birth would identify an individual to whom multiple hospitalizations belong. Matching with the algorithm reduced the 1986 case estimates from 597 to 499 for all cases of coal workers' pneumoconiosis, asbestosis, and silicosis.

Cotton Mather's Misnamed Diary: Reserved Memorials of a Representative Christian

Among autobiographical works by seventeenthand eighteenth-century Puritans, two overlapping manuscripts by Cotton Mather which were not published until the twentieth century hold a central place. Paterna, copied largely from Mather's Reserved Memorials, puts a very thin narrative frame on an anonymous father's record of personal religious experience for his son. And the much more widely read Reserved Memorials, usually referred to as Mather's diary, express the pious hopes, exercises, and literary and pastoral activities of a Christian who tries for more than forty years to bring his behavior into conformity with the will of God as events in his own life reveal that divine will to him. Close attention to some representative passages from different sections of the Reserved Memorials, ranging from the 1680s to the 1720s, should demonstrate both the cost of misreading the work as a mere diary and the value of noticing the narrator's retrospective emphasis.

Survey of Gastrointestinal Endoscopy Accidents in Israel, 1973/74

A nation-wide, anonymous record of endoscopy accidents showed that during 1973, 1470 upper gastrointestinal endoscopies and colonoscopies were performed. There were 3 fatalities (0.2%), 2 cardiovascular and one following an esophageal perforation. There were 2 other non-fatal cardiovascular complications (0.27%, including the fatal cases) and three other non-fatal perforations (0.27% including the fatal case). The overall morbidity being 0.34%. These figures compare unfavorably with other nation-wide series from the USA and Britain. It reflects the variable experience or the large number of examiners and trainees involved and the increasing number of poor-risk and elderly patients being examined.

Studies in forced compliance: commitment and magnitude of inducement to comply as determinants of opinion change.

Abstract : Subjects were enticed to record a strongly counterattitudinal statement about an important issue under three levels of commitment (anonymous audio recording, identified video recording with subsequent explanation or identified video recording with no opportunity to recant). 1/2 of the subjects were paid $.50 to make the recording; the other 1/2 were paid $2.50 for the counterattitudinal task. In the two higher commitment conditions (identified video recording), subjects given low financial inducement showed significantly more attitude change than those given the large reward. In the low commitment (anonymous audio recording) condition, large amounts of money produced more attitude change. (Author)

Contemporary Official Reports of the Proceedings at elections of Members of Parliament for the Shires of Roxburgh, Edinburgh, and Orkney, in 1628

Joseph Robertson presents three original documents from the 1628 records of the Privy Council of Scotland. All three records relate to the challenges of electing Commissioners to parliament, the first from the Sheriff of Teviotdale, the second an anonymous record from Midlothian, and the third from the Register of the Sheriffdom of Orkney. He goes on to discuss the difficulties in making representatives attend parliament in the seventeenth century and the ways in which parliament tried to encourage them to do so.