The meaningfulness of open data in Public Health and Healthcare

Background

The growing challenges and opportunities of Big Data for Public Health have revealed the potential to improve the efficiency and cost-effectiveness of public policy, for example through better targeting of resources with regard to General Practice (GP) prescribing. Open data has an important role due to its easy access and potential to complement proprietary data sources from, e.g., regional hospitals, and also itself be complemented with social data acquired by specialized approaches.

Methods

MIDAS pipeline of open source tools aiming integrating, analysing and visualising Open Data enabling health professionals and decision-makers to: (i) improve the usability of open data in combination with proprietary data through combining multiple visualisation tools in an integrated dashboard (ii) to explore the meaning of data in a global/local context based on new information using tone analysis and natural language techniques; and (iii) to have better informed decision-making based on evidence from trusted knowledge-bases. Specific data sources used have included information extracted from the biomedical database MEDLINE, worldwide news and government open data. Social media sources have also been used to gather information from the general public.

Results

Results include a strong correlation between antidepressant prescribing and economic deprivation, and a wide variation in how individual GP practices respond to demographic conditions. Automated anomaly detection based on the Local Outlier Probability has also been shown to be an easily understood and controllable approach to identifying prescribing outliers.

Conclusions

MIDAS demonstrates the significant value of open data from heterogeneous sources as basis decision-making in public health and healthcare, particularly when it is combined with proprietary or closed datasets. A key challenge in this regard is the ability to integrate and utilize data from diverse sources in a variety of formats and standards.

Key messages

MIDAS is exemplar on tackling the need for improved standards of open data, and new software architectures, tools and platforms addressing a complex ecosystem of heterogenous data sources and formats. MIDAS demonstrates the significant value of open data from heterogeneous sources as basis decision-making in public health and healthcare, particularly when combined with proprietary datasets.

Administration of erythropoiesis-stimulating agents in patients undergoing haemodialysis: A time and motion study

BACKGROUND

International guidelines recommend treatment of anaemia due to chronic kidney disease (CKD) with erythropoiesis-stimulating agents (ESAs).

OBJECTIVE

To document the time required and the cost in terms of nursing time to prepare and administer ESAs to patients on facility based haemodialysis (HD) with anaemia due to CKD before and after the introduction of long-acting ESAs.

DESIGN

A time and motion study was implemented at four HD units in Australia to determine the time and costs associated with preparing and administering ESAs before and after the introduction of long-acting ESAs.

PARTICIPANTS

This was a prospective, observational study of workplace practices at four HD units in Australia.

MEASUREMENTS

Outcome data included the time taken to prepare, and administer ESAs.

RESULTS

The time costs of preparation and administration per patient per year had a wide variability within each unit and ranged from Australian AUD$55.75 (38 euros) to AUD$90.49 (62 euros) before the introduction of long-acting ESAs. This dropped by 73-80% following the introduction of long-acting ESAs, representing an annual cost savings of between AUD$2,591 and AUD$5,914 if all patients on HD were switched to a long acting ESA.

CONCLUSION

Switching from a short-acting to a long-acting ESA in HD units leads to a significant reduction in time costs of health professionals in preparation and administration of ESAs by up to 80%. Practical application: This time and motion study has added further evidence on reduction of human effort by taking advantages of new research development, such as the long acting ESAs.

A case of recurrent severe pre-eclampsia associated with essential cryofibrinogenaemia

Essential cryofibrinogenaemia is a rare disorder characterized by cryofibrinogens without cryoglobulins. Connective tissue disorders and thrombophilia are known to increase risk of pre-eclampsia, but pre-eclampsia has not previously been reported in association with cryofibrinogenaemia. We report the case of a 32-year-old woman with recurrent severe pre-eclampsia diagnosed with essential cryofibrinogenaemia.

Pyrexia of unknown origin (PUO) in a hemodialysis patient

Patients with end stage renal disease (ESRD) are predisposed to malignancy. A patient who presented with a persisting fever, episodically above 38 degrees C, of unknown origin is described. The diagnosis of the illness remained elusive, over repeated hospital admissions and comprehensive investigations for over 11 weeks, until her last admission when the patient finally represented with features of acute liver cell failure and succumbed shortly afterwards. A liver biopsy revealed high grade lymphoma, an uncommon presentation for lymphoma. While malignancy is increased in dialysis patients, lymphoma is a relatively uncommon malignancy described. This case is a rare incidence of diffuse Non-Hodgkin's Lymphoma (NHL) isolated to the liver, causing fever, liver cell failure and death in a hemodialysis patient.

Hypersensitivity reactions to the polysorbate contained in recombinant erythropoietin and darbepoietin (Case Report)

The following case reports are of two patients who have developed hypersensitivity reactions to the red cell growth hormones, darbepoietin and erythropoietin. The subsequent skin testing and clinical course suggested that the cause of these reactions was due to the excipient polysorbate 80. This finding might have implications in the recent increase in the incidence of pure red cell aplasia.

Thyrotoxic period paralysis: report of three cases and review of the literature

Thyrotoxic periodic paralysis (TPP) is a neuromuscular disorder that, in a global perspective, only affects a small percentage of patients with thyrotoxicosis of any aetiology, but is a fairly common phenomenon in Asian populations where it predominantly occurs in males. Three typical cases are presented here. All three patients were Asian males, one being the first Laotian patient reported to have this disorder. In one case prodromal symptoms of TPP occurred during a relapse of the thyrotoxicosis. The epidemiology, clinical manifestations, aetiology and treatment of this relatively rare condition are discussed. As oriental races are now frequently encountered in the Western world, it is imperative that TPP is included in the differential diagnosis of muscle weakness in order to avoid the life-threatening complications of hypokalaemia and thyrotoxicosis.

Legionnaires' disease outbreak in south western Sydney, 1992. Clinical aspects

OBJECTIVES

To document the clinical, laboratory and radiological features of patients with Legionella pneumophila serogroup 1 pneumonia during an outbreak, and probe for any relationship between clinical or laboratory features and outcome.

DESIGN AND SETTING

Prospective identification of patients with Legionnaires' disease in an outbreak from 15-26 April 1992 in the South Western Sydney Area Health Service, centred on the Fairfield area.

PATIENTS

Twenty-six patients (22 men, four women) were confirmed to have the disease, based on the presence of clinical features of pneumonia, with L. pneumophila serogroup 1 isolated on culture, or evidence of seroconversion.

RESULTS

Seventeen patients (65.4%) were culture-positive for L. pneumophila serogroup 1 and nine were diagnosed on serological criteria. A direct fluorescent antibody (DFA) test of sputum performed well as a rapid diagnostic method. Twenty-three patients (89%) presented with hyponatraemia, 14 (54%) with renal impairment and nine of 19 (47%) with elevated serum creatinine phosphokinase levels. Overall mortality was 23% (71% for patients requiring mechanical ventilation). Eleven of 119 patients (10.2%) who did not have Legionnaires' disease showed serological evidence of previous exposure.

CONCLUSIONS

The duration of symptoms and severity of biochemical abnormalities at presentation were not related to outcome. The sputum DFA test is useful for rapid diagnosis during outbreaks.