To Err is Human, all hail your Robot Overseer: automated testing as part of a robust data delivery platform.

IntroductionWe have a large cohort study of half a million people, which continually incorporates new data through health insurance, centre for disease control records, death certificates, resurveys, and ongoing quality assurance and participant information updates. To support our researchers we need data which is correct, up-to-date, and unchanging. Objectives and ApproachWe must provide the new data, fixes and corrections to researchers, without missing anything or introducing issues. We make sequential iterations of our data available to researchers on a biannual basis; allowing a static version that can be referenced with regards to earlier work and providing the newest version of the data for new work. Due to the very large size of the data/code base and the small size of the team managing it, delivering this without error is a struggle. To mitigate this we developed testing scripts which catch issues and flag for resolution prior to release to researchers. ResultsWe currently have 32 tests which catch all known issues which occur during a rebuild. On any occasion where a new type of issue is encountered, tests which would catch that issue and related issues are developed. As a result our last few releases have gone far more smoothly, with few if any issues reported after a release and certainly no previously encountered issues! Examples of current tests include: detection of a failed health insurance import; that we have the same number of participants; failure to increment version number between releases; checking that disease numbers have not changed dramatically over the shared timeframe. Conclusion/ImplicationsProducing multiple static releases is a good way to balance the needs of a researcher for both static and current data, but it does introduce opportunities for both human and computer errors. Mitigating this risk with automated testing is convenient and effective.

Trends in AIDS-Associated Cancers among Patients Attending a Palliative Care Service in Uganda in the ’Pre-HAART’ Era, 1994–2002.

Objectives: To describe the pattern of AIDS-associated cancers among patients referred to a palliative care service in the absence of HAART therapy. Design: A systematic review of patient records as part of an ongoing quality assurance project. Setting: A primary palliative care service centre for cancer and/or AIDS patients in Kampala district, Uganda. Participants: All patient charts from 1994 to 2002 that met inclusion criteria (positive HIV test, or an AIDS diagnosing condition and AIDS-associated cancer) were selected. Results – 657 out of 3,706 (17.7%) patients met inclusion criteria. Fifty-two percent were female and the median age was 33 years. Thirty-nine percent were referred for pain and symptom control, 51.9% for pain control only, 7.0% for symptom control only; and 2.3% were referred for other reasons. Ninety-six percent were in pain and 95% of these had moderate-to-severe pain. Kaposi’s sarcoma was the most common AIDS associated malignancy, accounting for 73.2% of cases followed by invasive cancer of the cervix (15.1%), non-Hodgkin’s lymphoma (6.4%) and squamous cell carcinoma of the conjunctiva (1.8%). 83.4% had their pain well controlled at the time of death. Conclusions: The number and proportion of patients with Kaposi’s sarcoma declined over the study period. Pain control was achievable in most patients despite restrained resources.