Speaking the Same Language: Using Standardized Terminology

Are We Speaking the Same Language? Terminology Consistency in EBD

OBJECTIVE

The aim of this study is to analyze the consistency, variability, and potential standardization of terminology used to describe architectural variables (AVs) and health outcomes in evidence-based design (EBD) studies.

BACKGROUND

In EBD research, consistent terminology is crucial for studying the effects of AVs on health outcomes. However, there is a possibility that diverse terms have been used by researchers, which could lead to potential confusion and inconsistencies.

METHODS

Three recent large systematic reviews were used as a source of publications, and 105 were extracted. The analysis aimed to extract a list of the terms used to refer to the unique concepts of AVs and health outcomes, with a specific focus on people with dementia. Each term's frequency was calculated, and statistical tests, including the χ2 and the post hoc test, were employed to compare their distributions.

RESULTS

The study identified representative terms for AVs and health outcomes, revealing the variability in terminology usage within EBD field for dementia-friendly design. The comparative analysis of the identified terms highlighted patterns of frequency and distribution, shedding light on potential areas for standardization.

CONCLUSIONS

The findings emphasize the need for standardized terminologies in EBD to improve communication, collaboration, and knowledge synthesis. Standardization of terminology can facilitate research comparability, enhance the generalizability of findings by creating a common language across studies and practitioners, and support the development of EBD guidelines. The study contributes to the ongoing discourse on standardizing terminologies in the field and provides insights into strategies for achieving consensus among researchers, practitioners, and stakeholders in health environmental research.

Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia

The aim of this study was to investigate the severity of chronic vulvar pain in women with vulvodynia and its impact on their health-related quality of life (QL). The study group consisted of 76 women aged 19 to 58. The study was carried out using the diagnostic survey method, i.e., (1) the questionnaire technique, comprising (A) the author's questionnaire (76 questions) and (B) the WHOQOL-BREF questionnaire, and (2) the VAS. When analyzing the severity of vulvar pain on the VAS, the highest proportion of women rated it at level 6 (23.68%). This was significantly determined by certain personal characteristics (age < 25 years old) and sociodemographic characteristics (marital status: unmarried women, divorcees, widows; high school education), each at p < 0.05. Vulvodynia causes a significant deterioration (64.47%) in QL, which is mainly caused by a reduction in the ability to perform activities of daily living (27.63%) and a decrease in sexual satisfaction (27.63%). The level of stress significantly exacerbates pain (p < 0.05). The severity correlates significantly (p < 0.05) and negatively (r < 0) with QL perception, which was rated worst in the physical domain. The use of treatment resulted in a significant improvement in the physical and psychological domains (p < 0.05), and the latter was particularly influenced by physiotherapy (p < 0.05).

How Can We Quantify and Compare Harm in Surgical Trials?

PURPOSE

To describe methods that can be used to quantify and compare harm caused by surgical interventions in ophthalmology trials.

DESIGN

Perspective study.

METHODS

A published landmark glaucoma trial was used as an exemplar. A consensus-derived classification system of severity of complications was applied to published data of the Tube Versus Trabeculectomy glaucoma trial. The severity grade of each complication was multiplied to the number of patients who incurred that complication to estimate a total harm score for each intervention. Graphical tools were also used to display the differences in complications between trial arms. A review of literature on best practice for reporting harm data was also conducted.

RESULTS

Analyzing treatment harm is challenging with the relatively small number of events and sample sizes used in randomized controlled trials. However, quantification and graphical representation of harm after surgery is possible. Reframing the research question to one for detecting signals of adverse reactions and use of Bayesian analyses can be useful.

CONCLUSIONS

Analysis of harm data in clinical trials needs further attention. A severity classification system and a total harm score can be used to quantify harm after glaucoma surgery. Graphical tools can also help interpret complication data.

Harms in Systematic Reviews Paper 1: An introduction to research on harms

OBJECTIVE

Most systematic reviews of interventions focus on potential benefits. Common methods and assumptions that are appropriate for assessing benefits can be inappropriate for harms. This paper provides a primer on researching harms, particularly in systematic reviews.

STUDY DESIGN AND SETTING

Commentary describing challenges with assessing harm.

RESULTS

Investigators should be familiar with various terminologies used to describe, classify, and group harms. Published reports of clinical trials include limited information about harms, so systematic reviewers should not depend on these studies and journal articles to reach conclusions about harms. Visualizations might improve communication of multiple dimensions of harms such as severity, relatedness, and timing.

CONCLUSION

The terminology, classification, detection, collection, and reporting of harms create unique challenges that take time, expertise, and resources to navigate in both primary studies and evidence syntheses. Systematic reviewers might reach incorrect conclusions if they focus on evidence about harms found in published reports of randomized trials of a particular health problem. Systematic reviews could be improved through better identification and reporting of harms in primary studies and through better training and uptake of appropriate methods for synthesizing evidence about harms.

Defining Telehealth for Research, Implementation, and Equity (Preprint)

When the COVID-19 pandemic spurred a disruption in health care delivery, the role of telehealth shifted from an option to a near necessity to maintain access when in-person care was deemed too risky. Each state and many organizations developed temporary telehealth policies for the COVID-19 emergency, each policy with its own definitions, coverage, government cases, and regulations. As pandemic-era policies are now being replaced with more permanent guidelines, we are presented with an opportunity to reevaluate how telehealth is integrated into routine health care delivery. We believe that the timing and nature of the sequential steps for redefining telehealth are critical and that it is important to develop a clear and agreed-on definition of telehealth and its components at this time. We further suggest a necessary preliminary step is to support clear communication and interoperability throughout the development of this definition. Precise and standardized definitions could create an unambiguous environment for clinical care for both patients and providers while enabling researchers to have more precise control over their investigations of telehealth. A consensus when defining telehealth and its derivatives at this critical stage could create a consistent expectation of care for all patients and those who set the standards of care, as it has for other clinical scenarios with clear guidelines.

Effectiveness of Standardized Nursing Terminologies for Nursing Practice and Healthcare Outcomes: A Systematic Review

PURPOSE

This review evaluates the effectiveness of using standardized terminologies in nursing.

METHODS

A systematic literature review was performed via PubMed, Web of Science, CINAHL, and OVID databases for articles published between January 1973 and September 2020. The Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies was used to assess the quality of all included studies.

RESULTS

Fourteen studies were selected for data extraction and analysis, which included a total of 24,243 patients and 99 nurses. Of the studies that met the inclusion criteria, the quality of five were of high quality, one was of moderate quality, and eight was of weak quality. All articles were summarized according to two themes: the identification of common outcomes or interventions, and the validation or evaluation of the effectiveness of standard nursing terminology sets.

CONCLUSION

Standardized terminologies in nursing help nurses to implement care plans according to nursing procedures, supervise changes in patients' sensitive indicators, improve patients' health outcomes, and contribute to evidence-based nursing practices and global data resource sharing.

IMPLICATIONS FOR NURSING PRACTICE

Standardized nursing terminologies have positive effects on clinical practice, are essential for enriching nurses' knowledge, and alter nurses' attitudes regarding education and guidance, which promotes the clinical application of these terminologies.

Factors Influencing Problem List Use in Electronic Health Records-Application of the Unified Theory of Acceptance and Use of Technology

BACKGROUND

Problem-oriented electronic health record (EHR) systems can help physicians to track a patient's status and progress, and organize clinical documentation, which could help improving quality of clinical data and enable data reuse. The problem list is central in a problem-oriented medical record. However, current problem lists remain incomplete because of the lack of end-user training and inaccurate content of underlying terminologies. This leads to modifications of diagnosis code descriptions and use of free-text notes, limiting reuse of data.

OBJECTIVES

We aimed to investigate factors that influence acceptance and actual use of the problem list, and used these to propose recommendations, to increase the value of problem lists for (re)use.

METHODS

Semistructured interviews were conducted with physicians, heads of medical departments, and data quality experts, who were invited through snowball sampling. The interviews were transcribed and coded. Comments were fitted in constructs of the validated framework unified theory of acceptance user technology (UTAUT), and were discussed in terms of facilitators and barriers.

RESULTS

In total, 24 interviews were conducted. We found large variability in attitudes toward problem list use. Barriers included uncertainty about the responsibility for maintaining the problem list and little perceived benefits. Facilitators included the (re)design of policies, improved (peer-to-peer) training to increase motivation, and positive peer feedback and monitoring. Motivation is best increased through sharing benefits relevant in the care process, such as providing overview, timely generation of discharge or referral letters, and reuse of data. Furthermore, content of the underlying terminology should be improved and the problem list should be better presented in the EHR system.

CONCLUSION

To let physicians accept and use the problem list, policies and guidelines should be redesigned, and prioritized by supervising staff. Additionally, peer-to-peer training on the benefits of using the problem list is needed.

ASCCP Colposcopy Standards: Role of Colposcopy, Benefits, Potential Harms, and Terminology for Colposcopic Practice

OBJECTIVES

The American Society for Colposcopy and Cervical Pathology Colposcopy Standards address the role of and approach to colposcopy and biopsy for cervical cancer prevention in the United States. Working Group 1 was tasked with defining the role of colposcopy, describing benefits and potential harms, and developing an official terminology.

METHODS

A systematic literature review was performed. A national survey of American Society for Colposcopy and Cervical Pathology members provided input on current terminology use. The 2011 International Federation for Cervical Pathology and Colposcopy terminology was used as a template and modified to fit colposcopic practice in the United States. For areas without data, expert consensus guided the recommendation. Draft recommendations were posted online for public comment and presented at an open session of the 2017 International Federation for Cervical Pathology and Colposcopy World Congress for further comment. All comments were considered for the final version.

RESULTS

Colposcopy is used in the evaluation of abnormal or inconclusive cervical cancer screening tests. Colposcopy aids the identification of cervical precancers that can be treated, and it allows for conservative management of abnormalities unlikely to progress. The potential harms of colposcopy include pain, psychological distress, and adverse effects of the procedure. A comprehensive colposcopy examination should include documentation of cervix visibility, squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), lesion(s) visibility, size and location of lesions, vascular changes, other features of lesion(s), and colposcopic impression. Minimum criteria for reporting include squamocolumnar junction visibility, presence of acetowhitening, presence of a lesion(s), and colposcopic impression.

CONCLUSIONS

A recommended terminology for use in US colposcopic practice was developed, with comprehensive and minimal criteria for reporting.

Squamous intraepithelial lesions of the anal squamocolumnar junction: Histopathological classification and HPV genotyping

Background

Human papillomavirus (HPV)-related anal cancer lesions are often found adjacent to the squamocolumnar junction (SCJ). We have assessed the histopathology and associated HPV genotypes in anal SCJ lesions in surgically excised anal warts in HIV-negative and –positive patients.

Methods

Histopathology identified 47 squamous intraepithelial lesions (SILs) adjacent to the SCJ amongst a total of 145 cases of clinically diagnosed anal condylomata. The anal SCJ lesions were further analyzed with p16, CK7 and p63 immunohistochemistry and HPV genotyping.

Results

Sixteen (16/47) of the excised anal wart lesions contained HSIL; Three were HSIL and exclusively associated with oncogenic HPVs. A further thirteen (13/47) were mixed lesions. Of these eight were HSILs with LSIL and six were HSILs with papillary immature metaplasia (PIM); Ten of the mixed lesions were associated with one or more oncogenic HPVs, while three cases were exclusively associated with HPV6.

Conclusions

Clinically diagnosed anal warts cannot be assumed to be limited to low-grade lesions as anal warts of the SCJ often show heterogeneous lesions, with coexistence of LSIL, PIM, and HSIL. Lesions showing PIM, however, may mimic HSIL, because they are hypercellular, but lack the nuclear atypia and conspicuous mitotic activity of HSIL; and are p16 negative.

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Anal warts of the SCJ are often heterogeneous; with LSIL, including PIM and HSIL.

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Anal HSILs only with HPV6 may indicate that LR-HPVs have some role in oncogenesis.

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Recognition of PIM is important given its potential for being confused with HSIL.

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Clinical diagnosis of anal warts cannot be assumed to be limited to LSIL.

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Microscopic examination of anal warts is encouraged with appropriate immunostains.