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Billings WZ, Cleven A, Dworaczyk J, Dale AP, Ebell M, McKay B, Handel A. Use of Patient-Reported Symptom Data in Clinical Decision Rules for Predicting Influenza in a Telemedicine Setting. J Am Board Fam Med 2023; 36:766-776. [PMID: 37775324 PMCID: PMC10688580 DOI: 10.3122/jabfm.2023.230126r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Increased use of telemedicine could potentially streamline influenza diagnosis and reduce transmission. However, telemedicine diagnoses are dependent on accurate symptom reporting by patients. If patients disagree with clinicians on symptoms, previously derived diagnostic rules may be inaccurate. METHODS We performed a secondary data analysis of a prospective, nonrandomized cohort study at a university student health center. Patients who reported an upper respiratory complaint were required to report symptoms, and their clinician was required to report the same list of symptoms. We examined the performance of 5 previously developed clinical decision rules (CDRs) for influenza on both symptom reports. These predictions were compared against PCR diagnoses. We analyzed the agreement between symptom reports, and we built new predictive models using both sets of data. RESULTS CDR performance was always lower for the patient-reported symptom data, compared with clinician-reported symptom data. CDRs often resulted in different predictions for the same individual, driven by disagreement in symptom reporting. We were able to fit new models to the patient-reported data, which performed slightly worse than previously derived CDRs. These models and models built on clinician-reported data both suffered from calibration issues. DISCUSSION Patients and clinicians frequently disagree about symptom presence, which leads to reduced accuracy when CDRs built with clinician data are applied to patient-reported symptoms. Predictive models using patient-reported symptom data performed worse than models using clinician-reported data and prior results in the literature. However, the differences are minor, and developing new models with more data may be possible.
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Affiliation(s)
- W Zane Billings
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Annika Cleven
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Jacqueline Dworaczyk
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Ariella Perry Dale
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Mark Ebell
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Brian McKay
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM)
| | - Andreas Handel
- From the Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA (WZB, APD, ME, AH); Department of Mathematics, St. Olaf College, Northfield, MN (AC); Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ (JD); Department of Family and Consumer Sciences, University of Georgia, Athens, GA (BM).
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2
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Bertoli D, Steinkohl E, Mark EB, Brock C, Drewes AM, Frøkjaer JB. Quantification of gastric emptying with magnetic resonance imaging in healthy volunteers: A systematic review. Neurogastroenterol Motil 2022; 34:e14371. [PMID: 35340100 PMCID: PMC10078504 DOI: 10.1111/nmo.14371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several magnetic resonance imaging (MRI) protocols have been used to assess gastric emptying (GE) with MRI. This systematic review summarizes the current literature on the topic. The aim was to provide an overview of the available imaging protocols and underline the items that appear most agreed upon and those that deserve further investigation. METHODS According to PRISMA guidelines, two independent reviewers conducted a systematic literature search with a pre-specified strategy in different databases. Peer-reviewed articles that utilized MRI techniques to assess GE in healthy volunteers (HVs) were included. The quality and the outcomes of the studies were reported and analyzed. KEY RESULTS The literature search yielded 30 studies (531 HVs, weighted mean age 27.4, weighted mean body mass index 23.0 kg/m2 ), T2-weighted sequences, balanced turbo field echo, and balanced gradient echo were evenly utilized, with volunteers in the supine position (74% of the studies). After overnight fasting, both liquid (56%) and mixed (44%) meals were equally utilized. Segmentation of the volumes was predominantly performed manually (63%) with a reported mean T50 ranging from 7 to 330 min. CONCLUSIONS & INFERENCES As observed in this systematic review, MRI is a flexible tool for assessing GE. Different protocols were analyzed, showing an equal capacity to assess the GE. However, many items in these protocols still require further investigation to obtain a common standard and increase this assessment quality.
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Affiliation(s)
- Davide Bertoli
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emily Steinkohl
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
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3
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Indriyani W, Yudhistira MH, Sastiono P, Hartono D. The relationship between the built environment and respiratory health: Evidence from a longitudinal study in Indonesia. SSM Popul Health 2022; 19:101193. [PMID: 36105559 PMCID: PMC9464964 DOI: 10.1016/j.ssmph.2022.101193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple studies have discussed the relationship between the built environment and non-infectious diseases, but research involving infectious diseases and the built environment is scarce. How the built environment is associated with infectious diseases varies across areas, and previous literature produces mixed results. This study investigated the relationship between the built environment and infectious diseases in Indonesia, which has different settings compared to developed countries. We combined the longitudinal panel data, Indonesian Family Life Survey (IFLS), and land cover data to examine the relationship between the built environment and the likelihood of contracting respiratory infectious diseases. We focused on the sprawl index to measure the built environment. The study confirmed that a sprawling neighbourhood is linked to lower respiratory infection symptoms by employing a fixed effect method. The association is more evident in urban areas and for females. The results also suggested that the linkage works through housing quality, such as housing crowdedness and ventilation, and neighbourhood conditions like neighbourhood transportation modes and air pollution levels. Thus, our results underlined the need to consider the health consequences of the densification policy and determine the direction of landscape planning and policy.
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Affiliation(s)
- Witri Indriyani
- Research Cluster on Urban and Transportation Economics, Faculty of Economics and Business, Universitas Indonesia, Indonesia
- Research Cluster on Energy Modeling and Regional Economic Analysis (RCEMREA), Faculty of Economics and Business, Universitas Indonesia, Indonesia
| | - Muhammad Halley Yudhistira
- Research Cluster on Urban and Transportation Economics, Faculty of Economics and Business, Universitas Indonesia, Indonesia
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Indonesia
| | - Prani Sastiono
- Research Cluster on Urban and Transportation Economics, Faculty of Economics and Business, Universitas Indonesia, Indonesia
- Institute for Economic and Social Research, Faculty of Economics and Business, Universitas Indonesia, Indonesia
| | - Djoni Hartono
- Research Cluster on Energy Modeling and Regional Economic Analysis (RCEMREA), Faculty of Economics and Business, Universitas Indonesia, Indonesia
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4
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Qavi AJ, Wu C, Lloyd M, Zaman MMU, Luan J, Ballman C, Leung DW, Crick SL, Farnsworth CW, Amarasinghe GK. Plasmonic Fluor-Enhanced Antigen Arrays for High-Throughput, Serological Studies of SARS-CoV-2. ACS Infect Dis 2022; 8:1468-1479. [PMID: 35867632 PMCID: PMC9344907 DOI: 10.1021/acsinfecdis.2c00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Serological testing for acute infection or prior exposure is critical for patient management and coordination of public health decisions during outbreaks. Current methods have several limitations, including variable performance, relatively low analytical and clinical sensitivity, and poor detection due to antigenic drift. Serological methods for SARS-CoV-2 detection for the ongoing COVID-19 pandemic suffer from several of these limitations and serves as a reminder of the critical need for new technologies. Here, we describe the use of ultrabright fluorescent reagents, Plasmonic Fluors, coupled with antigen arrays that address a subset of these limitations. We demonstrate its application using patient samples in SARS-CoV-2 serological assays. In our multiplexed assay, SARS-CoV-2 antigens were spotted into 48-plex arrays within a single well of a 96-well plate and used to evaluate remnant laboratory samples of SARS-CoV-2 positive patients. Signal-readout was performed with Auragent Bioscience's Empower microplate reader, and microarray analysis software. Sample volumes of 1 μL were used. High sensitivity of the Plasmonic Fluors combined with the array format enabled us to profile patient serological response to eight distinct SARS-CoV-2 antigens and evaluate responses to IgG, IgM, and IgA. Sensitivities for SARS-CoV-2 antigens during the symptomatic state ranged between 72.5 and 95.0%, specificity between 62.5 and 100%, and the resulting area under the curve values between 0.76 and 0.97. Together, these results highlight the increased sensitivity for low sample volumes and multiplex capability. These characteristics make Plasmonic Fluor-enhanced antigen arrays an attractive technology for serological studies for the COVID-19 pandemic and beyond.
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Affiliation(s)
- Abraham J. Qavi
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Chao Wu
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Matthew Lloyd
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | | | - Jingyi Luan
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Claire Ballman
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Daisy W. Leung
- Department
of Internal Medicine, Washington University
School of Medicine, St. Louis, Missouri 63110, United States
| | - Scott L. Crick
- Auragent
Bioscience, St. Louis, Missouri 63108, United
States
| | - Christopher W. Farnsworth
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
| | - Gaya K. Amarasinghe
- Department
of Pathology & Immunology, Washington
University School of Medicine, St. Louis, Missouri 63110, United States
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5
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Schreiweis B, Brandner A, Bergh B. Applicability of Different Electronic Record Types for Use in Patient Recruitment Support Systems: Comparative Analysis. JMIR Form Res 2021; 5:e13790. [PMID: 34546175 PMCID: PMC8493461 DOI: 10.2196/13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 01/14/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Clinical trials constitute an important pillar in medical research. It is beneficial to support recruitment for clinical trials using software tools, so-called patient recruitment support systems; however, such information technology systems have not been frequently used to date. Because medical information systems' underlying data collection methods strongly influence the benefits of implementing patient recruitment support systems, we investigated patient recruitment support system requirements and corresponding electronic record types such as electronic medical record, electronic health record, electronic medical case record, personal health record, and personal cross-enterprise health record. Objective The aim of this study was to (1) define requirements for successful patient recruitment support system deployment and (2) differentiate and compare patient recruitment support system–relevant properties of different electronic record types. Methods In a previous study, we gathered requirements for patient recruitment support systems from literature and unstructured interviews with stakeholders (15 patients, 3 physicians, 5 data privacy experts, 4 researchers, and 5 staff members of hospital administration). For this investigation, the requirements were amended and categorized based on input from scientific sessions. Based on literature with a focus on patient recruitment support system–relevant properties, different electronic record types (electronic medical record, electronic health record, electronic medical case record, personal health record and personal cross-enterprise health record) were described in detail. We also evaluated which patient recruitment support system requirements can be achieved for each electronic record type. Results Patient recruitment support system requirements (n=16) were grouped into 4 categories (consent management, patient recruitment management, trial management, and general requirements). All 16 requirements could be partially met by at least 1 type of electronic record. Only 1 requirement was fully met by all 5 types. According to our analysis, personal cross-enterprise health records fulfill most requirements for patient recruitment support systems. They demonstrate advantages especially in 2 domains (1) supporting patient empowerment and (2) granting access to the complete medical history of patients. Conclusions In combination with patient recruitment support systems, personal cross-enterprise health records prove superior to other electronic record types, and therefore, this integration approach should be further investigated.
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Affiliation(s)
- Björn Schreiweis
- Institute for Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Antje Brandner
- Center for Information Technology and Medical Engineering, University Hospital Heidelberg, Heidelberg, Germany
| | - Björn Bergh
- Institute for Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
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6
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Smarr BL, Aschbacher K, Fisher SM, Chowdhary A, Dilchert S, Puldon K, Rao A, Hecht FM, Mason AE. Feasibility of continuous fever monitoring using wearable devices. Sci Rep 2020; 10:21640. [PMID: 33318528 PMCID: PMC7736301 DOI: 10.1038/s41598-020-78355-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/19/2020] [Indexed: 12/03/2022] Open
Abstract
Elevated core temperature constitutes an important biomarker for COVID-19 infection; however, no standards currently exist to monitor fever using wearable peripheral temperature sensors. Evidence that sensors could be used to develop fever monitoring capabilities would enable large-scale health-monitoring research and provide high-temporal resolution data on fever responses across heterogeneous populations. We launched the TemPredict study in March of 2020 to capture continuous physiological data, including peripheral temperature, from a commercially available wearable device during the novel coronavirus pandemic. We coupled these data with symptom reports and COVID-19 diagnosis data. Here we report findings from the first 50 subjects who reported COVID-19 infections. These cases provide the first evidence that illness-associated elevations in peripheral temperature are observable using wearable devices and correlate with self-reported fever. Our analyses support the hypothesis that wearable sensors can detect illnesses in the absence of symptom recognition. Finally, these data support the hypothesis that prediction of illness onset is possible using continuously generated physiological data collected by wearable sensors. Our findings should encourage further research into the role of wearable sensors in public health efforts aimed at illness detection, and underscore the importance of integrating temperature sensors into commercially available wearables.
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Affiliation(s)
- Benjamin L Smarr
- Department of Bioengineering and Halicioglu Data Science Institute, University of California, San Diego, 9500 Gilman Drive MC 0412, La Jolla, CA, 92093-0412, USA.
| | - Kirstin Aschbacher
- Division of Cardiology, School of Medicine, University of California, San Francisco, San Francisco, USA.,Health Data Architect, Science Team, Oura, San Francisco, USA
| | - Sarah M Fisher
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, USA
| | - Anoushka Chowdhary
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, USA
| | - Stephan Dilchert
- Department of Management, Baruch College, CUNY, New York and preValio LLC, Minneapolis, USA
| | - Karena Puldon
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adam Rao
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, USA
| | - Ashley E Mason
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, USA
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7
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Caring for the Workforce of a Health System During the COVID-19 Epidemic in Brazil: Strategies of Surveillance and Expansion of Access to Care. J Occup Environ Med 2020; 62:e593-e597. [PMID: 32826546 DOI: 10.1097/jom.0000000000002004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the strategies to monitor and expand access to care for a health system workers in the first 2 months of the COVID-19 epidemic in Brazil. METHODS Description of the implemented strategy based on the guidelines developed to address the surveillance and care of a large health system's workforce in the COVID-19 epidemic. RESULTS During phase 1, the surveillance strategy focused on monitoring suspected cases among employees. In phase 2, surveillance was restricted to employees with confirmed COVID-19, aiming at monitoring of symptoms and following hospitalizations. Access to care was expanded. A total of 1089 employees were diagnosed with COVID-19, 89 required hospitalizations and none had died. CONCLUSION The strategies adopted were promptly implemented and could be adapted to the changing epidemic dynamics, allowing low rates of adverse outcomes in this high-risk population.
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Perkes S, Bonevski B, Mattes J, Hall K, Gould GS. Respiratory, birth and health economic measures for use with Indigenous Australian infants in a research trial: a modified Delphi with an Indigenous panel. BMC Pediatr 2020; 20:368. [PMID: 32758202 PMCID: PMC7409441 DOI: 10.1186/s12887-020-02255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background There is significant disparity between the respiratory health of Indigenous and non-Indigenous Australian infants. There is no culturally accepted measure to collect respiratory health outcomes in Indigenous infants. The aim of this study was to gain end user and expert consensus on the most relevant and acceptable respiratory and birth measures for Indigenous infants at birth, between birth and 6 months, and at 6 months of age follow-up for use in a research trial. Methods A three round modified Delphi process was conducted from February 2018 to April 2019. Eight Indigenous panel members, and 18 Indigenous women participated. Items reached consensus if 7/8 (≥80%) panel members indicated the item was ‘very essential’. Qualitative responses by Indigenous women and the panel were used to modify the 6 months of age surveys. Results In total, 15 items for birth, 48 items from 1 to 6 months, and five potential questionnaires for use at 6 months of age were considered. Of those, 15 measures for birth were accepted, i.e., gestational age, birth weight, Neonatal Intensive Care Unit (NICU) admissions, length, head circumference, sex, Apgar score, substance use, cord blood gas values, labour, birth type, health of the mother, number people living in the home, education of mother and place of residence. Seventeen measures from 1-to 6 months of age were accepted, i.e., acute respiratory symptoms (7), general health items (2), health care utilisation (6), exposure to tobacco smoke (1), and breastfeeding status (1). Three questionnaires for use at 6 months of age were accepted, i.e., a shortened 33-item respiratory questionnaire, a clinical history survey and a developmental questionnaire. Conclusions In a modified Delphi process with an Indigenous panel, measures and items were proposed for use to assess respiratory, birth and health economic outcomes in Indigenous Australian infants between birth and 6 months of age. This initial step can be used to develop a set of relevant and acceptable measures to report respiratory illness and birth outcomes in community based Indigenous infants.
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Affiliation(s)
- Sarah Perkes
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
| | - Billie Bonevski
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Joerg Mattes
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Kerry Hall
- First Peoples Health Unit, (FPHU) Griffith University, Southport, Queensland, 4215, Australia
| | - Gillian S Gould
- Hunter Medical Research Institute and School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia
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9
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Smith SM, Whitaker KL, Cardy AH, Elliott AM, Hannaford PC, Murchie P. Validation of self-reported help-seeking, and measurement of the patient interval, for cancer symptoms: an observational study to inform methodological challenges in symptomatic presentation research. Fam Pract 2020; 37:91-97. [PMID: 31529030 DOI: 10.1093/fampra/cmz047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To improve earlier presentation with potential symptoms of cancer, accurate data are needed on how people respond to these symptoms. It is currently unclear how self-reported medical help-seeking for symptoms associated with cancer by people from the community correspond to what is recorded in their general practice records, or how well the patient interval (time from symptom onset to first presentation to a health-professional) can be estimated from patient records. METHOD Data from two studies that reviewed general practice electronic records of residents in Scotland, (i) the 'Useful Study': respondents to a general population survey who reported experiencing symptoms potentially associated with one of four common cancers (breast, colorectal, lung and upper gastro-intestinal) and (ii) the 'Detect Cancer Early' programme: cancer patients with one of the same four cancers. Survey respondents' self-reported help-seeking (yes/no) was corroborated; Cohen's Kappa assessed level of agreement. Combined data on the patient interval were evaluated using descriptive analysis. RESULTS 'Useful Study' respondents' self-report of help-seeking showed exact correspondence with general practice electronic records in 72% of cases (n = 136, kappa 0.453, moderate agreement). Between both studies, 1269 patient records from 35 general practices were reviewed. The patient interval could not be determined in 44% (n = 809) of symptoms presented by these individuals. CONCLUSIONS Patient self-report of help-seeking for symptoms potentially associated with cancer offer a reasonably accurate method to research responses to these symptoms. Incomplete patient interval data suggest routine general practice records are unreliable for measuring this important part of the patient's symptom journey.
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Affiliation(s)
- Sarah M Smith
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | | | - Amanda H Cardy
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | | | - Philip C Hannaford
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen
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10
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Li H, Mendelsohn E, Zong C, Zhang W, Hagan E, Wang N, Li S, Yan H, Huang H, Zhu G, Ross N, Chmura A, Terry P, Fielder M, Miller M, Shi Z, Daszak P. Human-animal interactions and bat coronavirus spillover potential among rural residents in Southern China. BIOSAFETY AND HEALTH 2019; 1:84-90. [PMID: 32501444 PMCID: PMC7148670 DOI: 10.1016/j.bsheal.2019.10.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
Human interaction with animals has been implicated as a primary risk factor for several high impact zoonoses, including many bat-origin viral diseases. However the animal-to-human spillover events that lead to emerging diseases are rarely observed or clinically examined, and the link between specific interactions and spillover risk is poorly understood. To investigate this phenomenon, we conducted biological-behavioral surveillance among rural residents in Yunnan, Guangxi, and Guangdong districts of Southern China, where we have identified a number of SARS-related coronaviruses in bats. Serum samples were tested for four bat-borne coronaviruses using newly developed enzyme-linked immunosorbent assays (ELISA). Survey data were used to characterize associations between human-animal contact and bat coronavirus spillover risk. A total of 1,596 residents were enrolled in the study from 2015 to 2017. Nine participants (0.6%) tested positive for bat coronaviruses. 265 (17%) participants reported severe acute respiratory infections (SARI) and/or influenza-like illness (ILI) symptoms in the past year, which were associated with poultry, carnivore, rodent/shrew, or bat contact, with variability by family income and district of residence. This study provides serological evidence of bat coronavirus spillover in rural communities in Southern China. The low seroprevalence observed in this study suggests that bat coronavirus spillover is a rare event. Nonetheless, this study highlights associations between human-animal interaction and zoonotic spillover risk. These findings can be used to support targeted biological behavioral surveillance in high-risk geographic areas in order to reduce the risk of zoonotic disease emergence.
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Affiliation(s)
- Hongying Li
- EcoHealth Alliance, New York, NY, USA
- School of Life Science, Engineering and Computing, Kingston University, London, UK
| | | | - Chen Zong
- School of Education and Human Development, University of Colorado Denver, Denver, CO, USA
| | - Wei Zhang
- Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
| | | | - Ning Wang
- Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Shiyue Li
- Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Huimin Huang
- School of Health Sciences, Wuhan University, Wuhan 430071, China
| | | | - Noam Ross
- EcoHealth Alliance, New York, NY, USA
| | | | - Philip Terry
- Directorate of Research, Business and Innovation, Kingston University, London, UK
| | - Mark Fielder
- School of Life Science, Engineering and Computing, Kingston University, London, UK
| | - Maureen Miller
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Zhengli Shi
- Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China
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11
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Maternal fever during pregnancy and offspring attention deficit hyperactivity disorder. Sci Rep 2019; 9:9519. [PMID: 31266998 PMCID: PMC6606630 DOI: 10.1038/s41598-019-45920-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/17/2019] [Indexed: 01/09/2023] Open
Abstract
Maternal fever during pregnancy is associated with several adverse child outcomes. We investigated associations between maternal fever and ADHD among offspring, as well as the sub-dimensions of ADHD - inattention and hyperactivity/impulsivity. Data came from the Norwegian Mother and Child Cohort Study, including more than 114,000 children. Information about children’s ADHD diagnoses was obtained from the Norwegian Patient Register. Mothers reported on inattention and hyperactivity/impulsivity symptoms in questionnaires at 8 years. Logistic regression analysis showed that children exposed to maternal fever in the first trimester received an ADHD diagnosis more often than unexposed children (Odds Ratio (OR) = 1.31, 95% confidence interval (CI) = 1.06–1.61). For children exposed twice or more in the first trimester, the OR was 2.64 (CI = 1.36–5.14). Linear regression analysis showed elevated inattention symptoms among children exposed to fever in the first (Cohen’s d = 0.09, CI = 0.03–0.15) and second (Cohen’s d = 0.05, CI = 0.01–0.09) trimester. Results were similar whether the mother had taken acetaminophen for their fever or not. Hyperactivity/impulsivity symptoms were not related to maternal fever. The results indicate that maternal fever in early pregnancy may be a risk factor for ADHD, and particularly for inattention problems. This risk is neither mitigated nor inflated by use of acetaminophen.
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12
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Ho PJ, Tan CS, Shawon SR, Eriksson M, Lim LY, Miao H, Png E, Chia KS, Hartman M, Ludvigsson JF, Czene K, Hall P, Li J. Comparison of self-reported and register-based hospital medical data on comorbidities in women. Sci Rep 2019; 9:3527. [PMID: 30837593 PMCID: PMC6400937 DOI: 10.1038/s41598-019-40072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Breast cancer patients commonly present with comorbidities which are known to influence treatment decisions and survival. We aim to examine agreement between self-reported and register-based medical records (National Patient Register [NPR]). Ascertainment of nine conditions, using individually-linked data from 64,961 women enrolled in the Swedish KARolinska MAmmography Project for Risk Prediction of Breast Cancer (KARMA) study. Agreement was assessed using observed proportion of agreement (overall agreement), expected proportion of agreement, and Cohen’s Kappa statistic. Two-stage logistic regression models taking into account chance agreement were used to identify potential predictors of overall agreement. High levels of overall agreement (i.e. ≥86.6%) were observed for all conditions. Substantial agreement (Cohen’s Kappa) was observed for myocardial infarction (0.74), diabetes (0.71) and stroke (0.64) between self-reported and NPR data. Moderate agreement was observed for preeclampsia (0.51) and hypertension (0.46). Fair agreement was observed for heart failure (0.40) and polycystic ovaries or ovarian cysts (0.27). For hyperlipidemia (0.14) and angina (0.10), slight agreement was observed. In most subgroups we observed negative specific agreement of >90%. There is no clear reference data source for ascertainment of conditions. Negative specific agreement between NPR and self-reported data is consistently high across all conditions.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Shajedur Rahman Shawon
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old road campus, OX3 7LF, Oxford, UK
| | - Mikael Eriksson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Li Yan Lim
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Hui Miao
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Eileen Png
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonas F Ludvigsson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, 118 84, Stockholm, Sweden
| | - Jingmei Li
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore. .,Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden. .,Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
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13
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Fares CM, Williamson TJ, Theisen MK, Cummings A, Bornazyan K, Carroll J, Spiegel ML, Stanton AL, Garon EB. Low Concordance of Patient-Reported Outcomes With Clinical and Clinical Trial Documentation. JCO Clin Cancer Inform 2018; 2:1-12. [PMID: 30652613 PMCID: PMC6724714 DOI: 10.1200/cci.18.00059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Health care research increasingly relies on assessment of data extracted from electronic medical records (EMRs). Clinical trial adverse event (AE) logs and patient-reported outcomes (PROs) are sources of data often available in the context of specific research projects. The aim of this study was to evaluate the extent of data concordance from these sources. PATIENTS AND METHODS Patients enrolled in clinical trials or receiving standard treatment for lung cancer (n = 62) completed validated questionnaires on physical and psychological symptoms at up to three assessment points. Temporally matched documentation was extracted from EMR notes and, for clinical trial participants (n = 41), AE logs. Evaluated data included symptom assessment, vital signs, medication logs, and laboratory values. Agreement (positive, negative) and Cohen's κ coefficients were calculated to assess concordance of symptoms among sources, with PROs considered the gold standard. RESULTS Patient-reported weight loss correlated significantly with clinical measurements ( t = 2.90; P = .02), and average number of PROs correlated negatively with albumin concentration, supporting PROs as the gold standard. Comparisons of PROs versus EMR yielded poor concordance across 11 physical symptoms, anxiety, and depressive symptoms (all κ < 0.40). Providers under-reported the presence of each symptom in the EMR compared with PROs. AE logs showed similarly poor concordance with PROs (all κ < 0.40, except shortness of breath). Negative agreement among sources was higher than positive agreement for all symptoms except pain. CONCLUSION There was poor concordance between EMR notes and AE logs with PROs. Findings suggest that EMR notes and AE logs may not be reliable sources for capturing physical and psychological symptoms experienced by patients with lung cancer, supporting use of PRO assessments in oncology practices.
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Affiliation(s)
| | | | | | - Amy Cummings
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - Krikor Bornazyan
- All authors: University of California, Los Angeles, Los Angeles, CA
| | - James Carroll
- All authors: University of California, Los Angeles, Los Angeles, CA
| | | | | | - Edward B. Garon
- All authors: University of California, Los Angeles, Los Angeles, CA
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14
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Usui M, Aramaki E, Iwao T, Wakamiya S, Sakamoto T, Mochizuki M. Extraction and Standardization of Patient Complaints from Electronic Medication Histories for Pharmacovigilance: Natural Language Processing Analysis in Japanese. JMIR Med Inform 2018; 6:e11021. [PMID: 30262450 PMCID: PMC6231790 DOI: 10.2196/11021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/07/2018] [Accepted: 08/25/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the growing number of studies using natural language processing for pharmacovigilance, there are few reports on manipulating free text patient information in Japanese. OBJECTIVE This study aimed to establish a method of extracting and standardizing patient complaints from electronic medication histories accumulated in a Japanese community pharmacy for the detection of possible adverse drug event (ADE) signals. METHODS Subjective information included in electronic medication history data provided by a Japanese pharmacy operating in Hiroshima, Japan from September 1, 2015 to August 31, 2016, was used as patients' complaints. We formulated search rules based on morphological analysis and daily (nonmedical) speech and developed a system that automatically executes the search rules and annotates free text data with International Classification of Diseases, Tenth Revision (ICD-10) codes. The performance of the system was evaluated through comparisons with data manually annotated by health care workers for a data set of 5000 complaints. RESULTS Of 5000 complaints, the system annotated 2236 complaints with ICD-10 codes, whereas health care workers annotated 2348 statements. There was a match in the annotation of 1480 complaints between the system and manual work. System performance was .66 regarding precision, .63 in recall, and .65 for the F-measure. CONCLUSIONS Our results suggest that the system may be helpful in extracting and standardizing patients' speech related to symptoms from massive amounts of free text data, replacing manual work. After improving the extraction accuracy, we expect to utilize this system to detect signals of possible ADEs from patients' complaints in the future.
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Affiliation(s)
- Misa Usui
- Division of Hospital Pharmacy Science, Graduate School of Pharmaceutical Sciences, Keio University, Tokyo, Japan
| | - Eiji Aramaki
- Social Computing Lab, Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Tomohide Iwao
- Social Computing Lab, Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Shoko Wakamiya
- Social Computing Lab, Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | | | - Mayumi Mochizuki
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, Tokyo, Japan.,Department of Pharmacy, Keio University Hospital, Tokyo, Japan
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15
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Smits DW, Backx F, Van Der Worp H, Van Middelkoop M, Hartgens F, Verhagen E, Kluitenberg B, Huisstede B. Validity of injury self-reports by novice runners: comparison with reports by sports medicine physicians. Res Sports Med 2018; 27:72-87. [PMID: 29969569 DOI: 10.1080/15438627.2018.1492399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 46 ± 11 yrs) of the "Start-to-Run" program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners' self-reports is low. Abbreviations: RRI: Running Related Injury; SMC: Sports Medicine Centre; MTU: Muscle Tendon Unit; PPV: Positive Predictive Value.
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Affiliation(s)
- Dirk-Wouter Smits
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Frank Backx
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Henk Van Der Worp
- b Center for Sports Medicine, University of Groningen , University Medical Center Groningen , Groningen , The Netherlands
| | - Marienke Van Middelkoop
- c Department of General Practice , Erasmus MC University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fred Hartgens
- d Departments of Epidemiology and Surgery, Research School CAPHRI , Maastricht University Medical Center+, and Sports Medicine Center Maastricht , Maastricht , The Netherlands
| | - Evert Verhagen
- e Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands.,f Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) , Federation University Australia, SMB Campus , Ballarat , Victoria , Australia
| | - Bas Kluitenberg
- b Center for Sports Medicine, University of Groningen , University Medical Center Groningen , Groningen , The Netherlands
| | - Bionka Huisstede
- a Department of Rehabilitation, Physical Therapy Science & Sports, Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands
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16
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Halline CG, Meyer T, Rosoklija I, Yerkes EB. Agreement between electronic medical records and self-reported urologic domains in the National Spina Bifida Patient Registry (NSBPR): Implications for future research. J Pediatr Urol 2017; 13:390.e1-390.e6. [PMID: 28655526 DOI: 10.1016/j.jpurol.2017.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Self-report (SR) is an efficient data collection method. However, SR data have been shown to be discrepant with medical record (MR) documentation, which raises questions about using SR to supplement retrospective chart review in research. In this study, pediatric spina bifida (SB) patients who completed SR interviews about continence status and personal bladder/bowel management were identified. We examined agreement between SR data and Urology provider notes in MRs. OBJECTIVE This study aimed to (1) identify demographic, medical, or methodological factors that might contribute to SR/MR disagreement; (2) postulate how these findings might be significant clinically; and (3) recommend improvements to SR data collection and MR documentation. STUDY DESIGN Our institution participates in the National Spina Bifida Patient Registry (NSBPR). NSBPR-enrolled subjects typically complete annual interviews about their urologic outcomes; we consider this to be a form of SR. After identifying patients who interviewed within 1 month of an encounter with a urology provider, we systematically reviewed and compared their SR responses to the MR. Overall SR/MR agreement (no. of agreeing data pairs/no. of complete data pairs) and strength of agreement (kappa, κ) were assessed. Agreement about daytime continence status was assessed for children ≥5 years or in younger children who were toilet trained. Analyses were also stratified by diagnosis, type of bladder management, and ethnicity. RESULTS Eleven urologic domains were analyzed for 176 patients. Overall SR/MR agreement was ≥90% for nine out of 11 domains (figure). Daytime urinary and stool incontinence (DUSI) domains demonstrated the lowest overall agreement, at 69% and 74% respectively. Patients with myelomeningocele (MM) and those on clean intermittent catheterization demonstrated twice as much SR/MR disagreement about DUSI than patients without MM and those who void. There was no significant difference in rates of SR/MR agreement about DUSI when analyzed by ethnicity, race, and ambulatory function status. Among cases of SR/MR disagreement about DUSI, the SR and MR had a roughly equal percentage of better outcomes reported for both UI and SI. DISCUSSION There was strong SR/MR agreement for the majority of urologic data we analyzed. Medically complex patients faced lower SR/MR agreement, which is consistent with findings in other patient populations. Biased reporting by patients/families or providers was not found. CONCLUSION Minimizing SR/MR disagreement through standardized data collection methods and tools, improved definitions of patient outcomes, and documentation of respondent identity will improve large, multisite studies that utilize SR and MR concurrently.
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Affiliation(s)
| | - Theresa Meyer
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ilina Rosoklija
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Elizabeth B Yerkes
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Valikodath NG, Newman-Casey PA, Lee PP, Musch DC, Niziol LM, Woodward MA. Agreement of Ocular Symptom Reporting Between Patient-Reported Outcomes and Medical Records. JAMA Ophthalmol 2017; 135:225-231. [PMID: 28125754 PMCID: PMC5404734 DOI: 10.1001/jamaophthalmol.2016.5551] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Accurate documentation of patient symptoms in the electronic medical record (EMR) is important for high-quality patient care. OBJECTIVE To explore inconsistencies between patient self-report on an Eye Symptom Questionnaire (ESQ) and documentation in the EMR. DESIGN, SETTING, AND PARTICIPANTS This investigation was an observational study in comprehensive ophthalmology and cornea clinics at an academic institution among a convenience sample of 192 consecutive eligible patients, of whom 30 declined participation. Patients were recruited at the Kellogg Eye Center from October 1, 2015, to January 31, 2016. Patients were eligible to be included in the study if they were 18 years or older. MAIN OUTCOMES AND MEASURES Concordance of symptoms reported on an ESQ with data recorded in the EMR. Agreement of symptom report was analyzed using κ statistics and McNemar tests. Disagreement was defined as a negative symptom report or no mention of a symptom in the EMR for patients who reported moderate to severe symptoms on the ESQ. Logistic regression was used to investigate if patient factors, physician characteristics, or diagnoses were associated with the probability of disagreement for symptoms of blurry vision, pain or discomfort, and redness. RESULTS A total of 162 patients (324 eyes) were included. The mean (SD) age of participants was 56.6 (19.4) years, 62.3% (101 of 162) were female, and 84.9% (135 of 159) were white. At the participant level, 33.8% (54 of 160) had discordant reporting of blurry vision between the ESQ and EMR. Likewise, documentation was discordant for reporting glare (48.1% [78 of 162]), pain or discomfort (26.5% [43 of 162]), and redness (24.7% [40 of 162]), with poor to fair agreement (κ range, -0.02 to 0.42). Discordance of symptom reporting was more frequently characterized by positive reporting on the ESQ and lack of documentation in the EMR (Holm-adjusted McNemar P < .03 for 7 of 8 symptoms except for blurry vision [P = .59]). Return visits at which the patient reported blurry vision on the ESQ had increased odds of not reporting the symptom in the EMR compared with new visits (odds ratio, 5.25; 95% CI, 1.69-16.30; Holm-adjusted P = .045). CONCLUSIONS AND RELEVANCE Symptom reporting was inconsistent between patient self-report on an ESQ and documentation in the EMR, with symptoms more frequently recorded on a questionnaire. These results suggest that documentation of symptoms based on EMR data may not provide a comprehensive resource for clinical practice or "big data" research.
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Affiliation(s)
- Nita G. Valikodath
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan
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18
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Fritz BA, Escallier KE, Ben Abdallah A, Oberhaus J, Becker J, Geczi K, McKinnon S, Helsten DL, Sharma A, Wildes TS, Avidan MS. Convergent Validity of Three Methods for Measuring Postoperative Complications. Anesthesiology 2016; 124:1265-76. [PMID: 27028469 PMCID: PMC5083125 DOI: 10.1097/aln.0000000000001108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anesthesiologists need tools to accurately track postoperative outcomes. The accuracy of patient report in identifying a wide variety of postoperative complications after diverse surgical procedures has not previously been investigated. METHODS In this cohort study, 1,578 adult surgical patients completed a survey at least 30 days after their procedure asking if they had experienced any of 18 complications while in the hospital after surgery. Patient responses were compared to the results of an automated electronic chart review and (for a random subset of 750 patients) to a manual chart review. Results from automated chart review were also compared to those from manual chart review. Forty-two randomly selected patients were contacted by telephone to explore reasons for discrepancies between patient report and manual chart review. RESULTS Comparisons between patient report, automated chart review, and manual chart review demonstrated poor-to-moderate positive agreement (range, 0 to 58%) and excellent negative agreement (range, 82 to 100%). Discordance between patient report and manual chart review was frequently explicable by patients reporting events that happened outside the time period of interest. CONCLUSIONS Patient report can provide information about subjective experiences or events that happen after hospital discharge, but often yields different results from chart review for specific in-hospital complications. Effective in-hospital communication with patients and thoughtful survey design may increase the quality of patient-reported complication data.
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Affiliation(s)
- Bradley A Fritz
- From the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
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19
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Echaiz JF, Cass C, Henderson JP, Babcock HM, Marschall J. Low correlation between self-report and medical record documentation of urinary tract infection symptoms. Am J Infect Control 2015; 43:983-6. [PMID: 26088770 PMCID: PMC4861684 DOI: 10.1016/j.ajic.2015.04.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Correlations between symptom documentation in medical records and patient self-report (SR) vary depending on the condition studied. Patient symptoms are particularly important in urinary tract infection (UTI) diagnosis, and this correlation for UTI symptoms is currently unknown. METHODS This is a cross-sectional survey study in hospitalized patients with Escherichia coli bacteriuria. Patients were interviewed within 24 hours of diagnosis for the SR of UTI symptoms. We reviewed medical records for UTI symptoms documented by admitting or treating inpatient physicians (IPs), nurses (RNs), and emergency physicians (EPs). The level of agreement between groups was assessed using Cohen κ coefficient. RESULTS Out of 43 patients, 34 (79%) self-reported at least 1 of 6 primary symptoms. The most common self-reported symptoms were urinary frequency (53.5%); retention (41.9%); flank pain, suprapubic pain, and fatigue (37.2% each); and dysuria (30.2%). Correlation between SR and medical record documentation was slight to fair (κ, 0.06-0.4 between SR and IPs and 0.09-0.5 between SR and EDs). Positive agreement was highest for dysuria and frequency. CONCLUSION Correlation between self-reported UTI symptoms and health care providers' documentation was low to fair. Because medical records are a vital source of information for clinicians and researchers and symptom assessment and documentation are vital in distinguishing UTI from asymptomatic bacteriuria, efforts must be made to improve documentation.
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Affiliation(s)
- Jose F Echaiz
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO
| | - Candice Cass
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO
| | - Jeffrey P Henderson
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO
| | - Hilary M Babcock
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO
| | - Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
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20
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De-loyde KJ, Harrison JD, Durcinoska I, Shepherd HL, Solomon MJ, Young JM. Which information source is best? Concordance between patient report, clinician report and medical records of patient co-morbidity and adjuvant therapy health information. J Eval Clin Pract 2015; 21:339-46. [PMID: 25645368 DOI: 10.1111/jep.12327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIM AND OBJECTIVES Previous studies investigating agreement between data sources for co-morbidity and adjuvant therapy information have suggested agreement varies depending on how the information is collected. The aim of this study was to compare agreement among three data sources: patient report, clinician report and medical record. METHOD Data were collected as part of a nurse-delivered telephone intervention (the CONNECT programme). Patient report was collected using a self-administered questionnaire. Clinician report was collected from the patient's treating surgeon. Medical record information was extracted by a member of the research team. The proportion of specific agreement [positive (PA) and negative agreement (NA)] and Kappa statistics were calculated. RESULTS The study sample comprised 756 surgical patients with colorectal cancer. For the majority of co-morbidities the lowest level of agreement was found between the patient and clinician (PA 0.29-0.64, Kappa values ranged from 0.22 to 0.58). The highest agreement and Kappa values for co-morbidities were generally found between the patient report and medical record (PA 0.36-0.80 and NA 0.92-0.99; Kappa 0.34-0.77). There was good agreement between patient and clinician reports for receipt adjuvant therapy {Kappa 0.78 [confidence interval (CI) 0.72-0.84] and 0.84 [CI 0.80-0.88], respectively; PA 0.87 and 0.92, respectively}. No consistent pattern in the predictors of non-agreement was found. CONCLUSION Given there was higher agreement between patient report and medical record review, the use of patient self-report questionnaires to ascertain co-morbid conditions remains a valid method for health services research.
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Affiliation(s)
- Katie J De-loyde
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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21
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Weakley J, Webber MP, Ye F, Zeig-Owens R, Cohen HW, Hall CB, Kelly K, Prezant DJ. Agreement between upper respiratory diagnoses from self-report questionnaires and medical records in an occupational health setting. Am J Ind Med 2014; 57:1181-7. [PMID: 25223518 DOI: 10.1002/ajim.22353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Fire Department of the City of New York World Trade Center Health Program (FDNY-WTCHP) monitors and treats WTC-related illnesses through regular physical exams, self-administered health questionnaires and treatment visits, as indicated. METHODS We measured positive and negative predictive values (PPV, NPV) of self-reported diagnoses of GERD and rhinosinusitis from the health questionnaires in relation to FDNY physician diagnoses from the medical record. RESULTS Self-reported GERD had PPV and NPV of 54.0% and 95.7%, respectively; for rhinosinusitis, the PPV and NPV were 48.2% and 91.9%. These characteristics improved considerably (PPV 78.0% GERD and PPV 76.5% rhinosinusitis) in a subpopulation receiving medications from the FDNY-WTCHP. CONCLUSION The PPV of self-reported diagnoses demonstrates only modest value in predicting physician diagnoses, although high NPVs suggest benefit in ruling out disease. In subgroups selected for their higher disease prevalence, self-reported diagnoses may be considerably more useful.
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Affiliation(s)
- Jessica Weakley
- Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Mayris P. Webber
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Fen Ye
- Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Rachel Zeig-Owens
- Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - Hillel W. Cohen
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York
| | - Charles B. Hall
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York
| | - Kerry Kelly
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
| | - David J. Prezant
- Bureau of Health Services; Fire Department of the City of New York; Brooklyn New York
- Department of Pulmonary Medicine; Montefiore Medical Center and Albert Einstein College of Medicine; Bronx New York
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22
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Bai JR, Mukherjee DV, Befus M, Apa Z, Lowy FD, Larson EL. Concordance between medical records and interview data in correctional facilities. BMC Med Res Methodol 2014; 14:50. [PMID: 24716525 PMCID: PMC3991914 DOI: 10.1186/1471-2288-14-50] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 03/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background Self- administered questionnaires or interviews and medical records are often used as sources of research data; thus it is essential to evaluate their concordance and reliability. The aim of this paper was to assess the concordance between medical and behavioral data obtained from medical records and interview questionnaires in two correctional facilities. Methods Medical record and interview data were compared for 679 inmates from one male and one female maximum security prison between April 2010 and February 2013. Gender non-stratified and gender-stratified analyses were conducted in SPSS to calculate the prevalence and kappa coefficient scores (κ) for medical (e.g., HIV, diabetes, hypertension) and behavioral (e.g., smoking, drug use, tattoos) conditions. Sensitivity/specificity between medical records and interview were calculated in the gender non-stratified data. Results In the gender non-stratified analysis, κ score for HIV, hepatitis C, diabetes, asthma, and history of tattoos had strong or good concordance (0.66-0.89). Hypertension, renal/kidney disease, cigarette smoking, antibiotic use in the last 6 months, and cocaine use ever were moderately correlated (0.49-0.57). Both history of any illicit drug use ever (0.36) and marijuana use ever (0.23) had poor concordance. Females had higher κ scores and prevalence rates than males overall. Medical conditions were reported more frequently in medical records and behavioral conditions had higher prevalence in interviews. Sensitivity for medical conditions in the combined facility data ranged from 50.0% to 86.0% and 48.2% to 85.3% for behavioral conditions whereas specificity ranged from 95.9% to 99.5% for medical conditions and 75.9% to 92.8% for behavioral conditions. Conclusion Levels of agreement between medical records and self-reports varied by type of factor. Medical conditions were more frequently reported by chart review and behavioral factors more frequently by self-report. Data source used may need to be chosen carefully depending upon the type of information sought.
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Affiliation(s)
- Jennifer R Bai
- School of Nursing, Columbia University, New York, NY, USA.
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23
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Iyer S, Roughley A, Rider A, Taylor-Stokes G. The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study. Support Care Cancer 2013; 22:181-7. [DOI: 10.1007/s00520-013-1959-4] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
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24
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Harrington KF, Haven KM, Nuño VL, Magruder T, Bailey WC, Gerald LB. Parent report and electronic medical record agreement on asthma education provided and children's tobacco smoke exposure. J Asthma 2013; 50:968-74. [PMID: 23883356 DOI: 10.3109/02770903.2013.828303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the concordance between parent report and electronic medical record documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma. METHODS Parents of children with asthma were recruited from two types of clinics using different electronic medical record systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medical records for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types. RESULTS Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (κ = 0.410 versus 0.205), asthma diagnosis/disease process (κ = 0.213 versus -0.016) and devices reviewed (κ = 0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medical records, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere. CONCLUSIONS We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.
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Affiliation(s)
- Kathleen F Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama , Birmingham, AL , USA
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25
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Wade TJ, Sams EA, Beach MJ, Collier SA, Dufour AP. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environ Health 2013; 12:67. [PMID: 23962340 PMCID: PMC3765573 DOI: 10.1186/1476-069x-12-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/19/2013] [Indexed: 05/26/2023]
Abstract
BACKGROUND Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. METHODS Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming. RESULTS The overall incidence of self-reported earache was 1.6% in the 10-12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively. CONCLUSIONS There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates.
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Affiliation(s)
- Timothy J Wade
- Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Elizabeth A Sams
- Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Michael J Beach
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah A Collier
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfred P Dufour
- Office of Research and Development, United States Environmental Protection Agency, Cincinnati, OH, USA
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McCaw JM, Howard PF, Richmond PC, Nissen M, Sloots T, Lambert SB, Lai M, Greenberg M, Nolan T, McVernon J. Household transmission of respiratory viruses - assessment of viral, individual and household characteristics in a population study of healthy Australian adults. BMC Infect Dis 2012; 12:345. [PMID: 23231698 PMCID: PMC3538067 DOI: 10.1186/1471-2334-12-345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/06/2012] [Indexed: 02/04/2023] Open
Abstract
Background Household transmission of influenza-like illness (ILI) may vary with viral and demographic characteristics. We examined the effect of these factors in a population-based sample of adults with ILI. Methods We conducted a prospective cohort study in community-dwelling Australian adults nested within an influenza vaccine effectiveness trial. On presentation with ILI, participants were swabbed for a range of respiratory viruses and asked to return a questionnaire collecting details of household members with or without similar symptoms. We used logistic and Poisson regression to assess the key characteristics of household transmission. Results 258 participants from multi-occupancy households experienced 279 ILI episodes and returned a questionnaire. Of these, 183 were the primary case in the household allowing assessment of factors associated with transmission. Transmission was significantly associated in univariate analyses with female sex (27% vs. 13%, risk ratio (RR) = 2.13 (1.08, 4.21)) and the presence of a child in the house (33% vs. 17%, RR = 1.90 (1.11, 3.26)). The secondary household attack proportion (SHAP) was 0.14, higher if influenza was isolated (RR = 2.1 (1.0, 4.5)). Vaccinated participants who nonetheless became infected with influenza had a higher SHAP (Incidence RR = 5.24 (2.17, 12.6)). Conclusions The increased SHAP in households of vaccinated participants who nonetheless had confirmed influenza infection supports the hypothesis that in years of vaccine mismatch, not only is influenza vaccine less protective for the vaccine recipient, but that the population’s immunity is also lower.
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Affiliation(s)
- James M McCaw
- Murdoch Children's Research Institute & Melbourne School of Population Health, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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27
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Dawson I, Senior V, de Lusignan S. Perceptions of risk may explain the discrepancy between patient and clinician-recorded symptoms. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:124-6. [PMID: 22362310 PMCID: PMC6547919 DOI: 10.4104/pcrj.2012.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2012] [Indexed: 07/18/2024]
Affiliation(s)
- Ian Dawson
- Lecturer in Human Resource Management & Organisational Behaviour, The Surrey Business School, University of Surrey, UK
| | - Victoria Senior
- Senior Lecturer in Health Psychology, School of Psychology, University of Surrey, UK
| | - Simon de Lusignan
- Professor of Primary Care and Clinical Informatics, Department of Health Care Management and Policy, University of Surrey, UK
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28
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A comparison of self-report and health care provider data to assess surveillance definitions of influenza-like illness in outpatients. Canadian Journal of Public Health 2012. [PMID: 22338332 DOI: 10.1007/bf03404072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Several surveillance definitions of influenza-like illness (ILI) have been proposed, based on the presence of symptoms. Symptom data can be obtained from patients, medical records, or both. Past research has found that agreements between health record data and self-report are variable depending on the specific symptom. Therefore, we aimed to explore the implications of using data on influenza symptoms extracted from medical records, similar data collected prospectively from outpatients, and the combined data from both sources as predictors of laboratory-confirmed influenza. METHODS Using data from the Hutterite Influenza Prevention Study, we calculated: 1) the sensitivity, specificity and predictive values of individual symptoms within surveillance definitions; 2) how frequently surveillance definitions correlated to laboratory-confirmed influenza; and 3) the predictive value of surveillance definitions. RESULTS Of the 176 participants with reports from participants and medical records, 142 (81%) were tested for influenza and 37 (26%) were PCR positive for influenza. Fever (alone) and fever combined with cough and/or sore throat were highly correlated with being PCR positive for influenza for all data sources. ILI surveillance definitions, based on symptom data from medical records only or from both medical records and self-report, were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values. DISCUSSION The choice of data source to determine ILI will depend on the patient population, outcome of interest, availability of data source, and use for clinical decision making, research, or surveillance.
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Pieterse QD, Ter Kuile MM, Maas CP, Kenter GG. The Gynaecologic Leiden Questionnaire: psychometric properties of a self-report questionnaire of sexual function and vaginal changes for gynaecological cancer patients. Psychooncology 2008; 17:681-9. [PMID: 17992699 PMCID: PMC4801326 DOI: 10.1002/pon.1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study was to investigate the psychometric properties of the items concerning sexual functioning of the Gynaecologic Leiden Questionnaire (LQ), which consists of items for post operative morbidity for women with cancer. METHODS The total study sample consisted of 198 subjects: 66 patients treated for cervical cancer, 66 patients with sexual complaints and 66 subjects from the general population. RESULTS By means of factor analysis three subscales were derived: Female Sexual Complaints, Female Sexual Function and Female Orgasm. The reliability of the subscales appeared to be satisfactory. The scores on the three subscales differentiated well between the patients treated for cervical cancer, patients with sexual complaints and the subjects from the general population. Furthermore, the subscales were sensitive to changes within the patients treated for cervical cancer. The convergent and divergent construct validities of the LQ were investigated using other instruments measuring sexual functioning, sexual dissatisfaction, marital distress, general life distress and psychological distress. The LQ subscales were found to represent relatively independent constructs. CONCLUSION The results support the reliability and psychometric validity of the LQ in the assessment of sexual functioning and vaginal changes in gynaecological cancer patients.
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Affiliation(s)
- Q D Pieterse
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands. Q.
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