1st Annual EUBIROD meeting Dasman Center for Research and Treatment of Diabetes, Kuwait City Kuwait City, Kuwait, 2nd-4th May 2009

Training

Aims of the training session at the First Residential Meeting in Kuwait were: to induce EUBIROD partners who were not experienced in the BIRO system to understand the approach in its practical application, using software on test datasets either extracted from local registers, or directly supplied by the EUBIROD Coordinating Centre as a software bundle to introduce all EUBIROD partners to the use of the BIRO Box, an interactive Graphic User Interface (GUI) that integrates all BIRO functions into a comprehensive tool.

The training session was divided in three parts:

• the first afternoon, to introduce technicalities and to prepare all computers for the application of the BIRO system through the installation of software components distributed by third parties (e.g. Java, R, Latex, etc). Here the plan was also to export test/local data to the XML BIRO format.


• the second afternoon, dedicated to introduce a case study on the standardization of Kuwait data for the statistical analysis and direct usage of BIRO, followed by the continuation of the previous session to carry out basic statistical analysis and further processing of aggregate data


• the third morning, to produce the BIRO reports

Extensive technical details of the training session can be found here.

Presentation and content of Kuwait data analysis briefed by Dr.Mona Al Khawari (Al Amiri Hospital, Kuwait City, Kuwait) are available here.

Video streaming of the final discussion on the resulting BIRO reports is available here.

An example of a BIRO report obtained at the end of the session can be downloaded here.

Executive summary of the session

Installation of the software

Setup of all software involved installation of a list of products from third parties and creation of required environment variables.

This part of the session unexpectedly proved to be most difficult. Countless problems were encountered, due to the different operating systems, different hardware, different behaviours of software packages available from accredited third parties (e.g. Postgres, Java, R, Latex). Fixing environment variables was extremely difficult on Windows machines. Bypassing administrative privileges at different levels was time consuming and in some cases could not be resolved.

Our experience shows that a broad range of hardware/software options translate into unavoidable problems that may be hard to overcome at a meeting. Nevertheless, the resulting indications are very useful, as they provide important information on how to improve the system and optimise training. To this end, setup should be automated and must be tested in advance by partners. Feedback must be continuously provided to the development team. Minimal requirements must be set for machines to be accepted at any training session. Difficult OS e.g. Vista should be discouraged, while Linux-operated PCs should be further promoted. Novel solutions e.g. virtualization or live distributions may also be explored. The supporting team should define in any case a procedure and contingency plan, to avoid unmanageable delays and activity breaks. Internet connection should be faster and more reliable.

Loading data

This phase included exporting local data to the BIRO XML format and loading data on the Postgres database. In the first step, data tables from diabetes registers were exported to a BIRO format and be loaded into a BIRO-standardized Postgres database. The result is a zip file including XML files for all patients in the register according to consistent coding. To perform such operation, mapping is required from local coding to the BIRO coding.

In most cases, the tool included in the BIRO Box worked fine. However, it is practically impossible to cope with all possible coding situations and some minimal requirements must be set in advance. To solve problems, in some cases it was necessary to intervene on the original data, either by adding a dummy field and populating the database with constant values, or correcting errors in dates, etc.

Our experience shows that it is necessary that the original databases are correct, regardless of the particular coding. There is a need for more training at the level of the local centre. Database software should quality checks that evidently are not present, based upon our observation of test data.

Some of these inconsistencies were also reflected in the following step: loading data into the Postgres database.

In the end, after substantial data tweaking from the supporting team, almost all partners succeeded in loading the database. In most complicated cases, partners opted for using test data provided by the Coordinating Centre to complete the training session.

Running the statistical engine

The aim of this phase it so connect directly to the Postgres database to load target fields and to produce the final report.

Even in this case, a specific routine is included in the BIRO Box to complete this task. Application shows that the engine rightly rejects data not properly translated into the Postgres database. Many adjustments were required to check the content of original datasets and correct mistakes where present. The source code of the statistical engine was also improved to take into account unexpected situations. Several bugs were also corrected.

At the end of the process, many partners succeeded in delivering correct reports, first of all Germany, Austria, Malta, Poland, Croatia, Kuwait.

Participants agreed to take the case of Germany as a basis for discussion and examined all outputs in detail, making comments on each indicator.

Other cases were also examined. In particular, the case of Kuwait was very useful being the only pediatric database in the training session. This case demonstrated that ew partners may use BIRO, but also that specific pediatric indicators must be added to the BIRO dictionary since the current format is inadequate for such population.

Partners agreed to maintain close web communication to continue testing the software, and to reconvene in Kuwait for an advanced educational session in 2010.