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Doering S, Probert-Lindström S, Ehnvall A, Wiktorsson S, Palmqvist Öberg N, Bergqvist E, Stefenson A, Fransson J, Westrin Å, Waern M. Anxiety symptoms preceding suicide: A Swedish nationwide record review. J Affect Disord 2024; 355:317-324. [PMID: 38552915 DOI: 10.1016/j.jad.2024.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide. METHODS Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity. RESULTS Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death. LIMITATIONS Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents. CONCLUSIONS Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.
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Affiliation(s)
- Sabrina Doering
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Psychiatric Outpatient Clinic, Region Halland, Varberg, Sweden
| | - Stefan Wiktorsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Nina Palmqvist Öberg
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Erik Bergqvist
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Psychiatric Inpatient Clinic, Region Halland, Varberg, Sweden
| | - Anne Stefenson
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Fransson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Souza-Oliveira AC, Paschoal MAB, Alvarenga-Brant R, Martins CC. Frequency of missing data in clinical records in pediatric dentistry: a descriptive study. J Clin Pediatr Dent 2023; 47:44-49. [PMID: 36627219 DOI: 10.22514/jocpd.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the frequency of missing data on routine dental care appointments and restorative procedures from the clinical records of children treated at a pediatric dental clinic. A descriptive retrospective study was conducted involving the clinical records of children three to 12 years of age treated only with restorations. The inclusion criteria were clinical records from the past 10 years of children with at least one restored tooth. Data collection was performed by a trained examiner who extracted information from the clinical records on appointments for routine dental care and restorative procedures. The frequency of missing data on clinical records was submitted to descriptive analysis. Among the 249 clinical records analyzed, boys accounted for little more than half (54.2%) and mean patient age was 6.9 ± 1.8 years. Ninety-four of the 249 clinical records were of appointments for routine dental care. Missing data were found for the gingival bleeding index (18.1%), visible plaque index (22.3%) and dietary logs (74.5%). Forty-seven children were submitted to a total of 618 restorative procedures. Information was missing on the type of restorative material (5%), brand of the material used (65.2%), the type of isolation (50.8%) and whether pulp capping was performed (75.9%). The percentage of missing data from clinical records was substantial, demonstrating that important information is not recorded during routine dental care or restorative procedures.
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Affiliation(s)
- Ana Clara Souza-Oliveira
- Department of Pediatric Dentistry, Dental School, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Marco Aurélio Benini Paschoal
- Department of Pediatric Dentistry, Dental School, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Rachel Alvarenga-Brant
- Department of Clinical Oral Pathology and Oral Surgery, Dental School, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry, Dental School, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, Brazil
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Tsubonouchi C, Kinoshita Y, Nomura N. The patient-authored medical record: A narrative path to a new tool in psychiatric nursing. Arch Psychiatr Nurs 2022; 39:46-53. [PMID: 35688543 DOI: 10.1016/j.apnu.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/14/2021] [Accepted: 03/13/2022] [Indexed: 11/02/2022]
Abstract
This paper describes preliminary research from Japan on developing a new tool for psychiatric nurses, the patient-authored medical record, a "prescription" written in ordinary language by the patient with the assistance of a nurse. The nurse asks the patient how to improve their illness and she types up the patient's story on site in the form of a first-person narrative. The patient checks it for accuracy before taking a copy home. Ten Japanese patients participated in this field-oriented ethnographic study, and the analysis of the qualitative data strongly suggested that the approach had therapeutic effects on each patient. This narrative-based prescription could be used as a tool, specifically by psychiatric nurses, in many cultures, and it is our hope that it contributes to their professional identity.
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Affiliation(s)
- Chizuru Tsubonouchi
- School of Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya City, Japan; School of Nursing, Japanese Red Cross Toyota College of Nursing, Toyota City, Japan
| | | | - Naoki Nomura
- Graduate School of Humanities and Social Sciences, Nagoya City University, Nagoya City, Japan.
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Meidani Z, Atoof F, Mobarak Z, Nabovati E, Daneshvar Kakhki R, Kouchaki E, Fakharian E, Nickfarjam AM, Holl F. Development of clinical-guideline-based mobile application and its effect on head CT scan utilization in neurology and neurosurgery departments. BMC Med Inform Decis Mak 2022; 22:106. [PMID: 35443649 PMCID: PMC9020029 DOI: 10.1186/s12911-022-01844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is little evidence regarding the adoption and intention of using mobile apps by health care professionals (HCP) and the effectiveness of using mobile apps among physicians is still unclear. To address this challenge, the current study seeks two objectives: developing and implementing a head CT scan appropriateness criteria mobile app (HAC app), and investigating the effect of HAC app on CT scan order.
Methods A one arm intervention quasi experimental study with before/after analysis was conducted in neurology & neurosurgery (N&N) departments at the academic hospital. We recruited all residents' encounters to N&N departments with head CT scan to examine the effect of HAC app on residents' CT scan utilization. The main outcome measure was CT scan order per patient for seven months at three points, before the intervention, during the intervention, after cessation of the intervention -post-intervention follow-up. Data for CT scan utilization were collected by reviewing medical records and then analyzed using descriptive statistics, Kruskal-Wallis, and Mann-Whitney tests. A focus group discussion with residents was performed to review and digest residents' experiences during interaction with the HAC app. Results Sixteen residents participated in this study; a total of 415 N&N encounters with CT scan order, pre-intervention 127 (30.6%), intervention phase 187 (45.1%), and 101 (24.3%) in the post-intervention follow-up phase were included in this study. Although total CT scan utilization was statistically significant during three-time points of the study (P = 0.027), no significant differences were found for CT utilization after cessation of the intervention (P = 1). Conclusion The effect of mobile devices on residents' CT scan ordering behavior remains open to debate since the changes were not long-lasting. Further studies based on real interactive experiences with mobile devices is advisable before it can be recommended for widespread use by HCP.
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Affiliation(s)
- Zahra Meidani
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran. .,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Fatemeh Atoof
- Department of Biostatistics & Epidemiology, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohre Mobarak
- Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Daneshvar Kakhki
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ebrahim Kouchaki
- Department of Neurology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management and Technology, Faculty of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, University of Munich, Munich, Germany
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Parikh R, Hess LM, Esterberg E, Bhandari NR, Kaye JA. Diagnostic characteristics, treatment patterns, and clinical outcomes for patients with advanced/metastatic medullary thyroid cancer. Thyroid Res 2022; 15:2. [PMID: 35151352 PMCID: PMC8840546 DOI: 10.1186/s13044-021-00119-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background Medullary thyroid cancer (MTC) accounts for approximately 1.6% of new cases of thyroid cancer. The objective of this study was to describe patient characteristics, biomarker testing, treatment patterns, and clinical outcomes among patients with advanced/metastatic MTC in a real-world setting in the United States and to identify potential gaps in the care of these patients. Methods Selected oncologists retrospectively reviewed medical records of patients aged ≥ 12 years diagnosed with advanced MTC. Patients must have initiated ≥ 1 line of systemic treatment for advanced/metastatic MTC between January 2013–December 2018 to be eligible. Patient characteristics, biomarker testing, and treatment patterns were summarized descriptively; progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Results The 203 patients included in this study had a mean (SD) age of 52.2 (10.4) years; mean (SD) duration of follow-up from start of first-line treatment was 24.5 (16.0) months. Most patients (82.8%) were initially diagnosed with stage IVA, IVB, or IVC disease. Among all patients, 121 (59.6%) had testing for RET mutations, of whom 37.2% had RET-mutant MTC. The RET-mutation type was reported for 28 patients; the most common mutations reported were M918T (64.3%) and C634R (32.1%). Of the 203 patients, 75.9% received only one line of systemic treatment for advanced disease, and 36% were still undergoing first-line therapy at the time of data extraction. Cabozantinib (30.0%), vandetanib (30.0%), sorafenib (17.2%), and lenvatinib (4.9%) were the most common first-line treatments. Among 49 patients who received second-line treatment, most received cabozantinib (22.4%), vandetanib (20.4%), lenvatinib (12.2%), or sunitinib (12.2%). Median PFS (95% confidence interval [CI]) from start of first- and second-line treatments was 26.6 months (20.8–60.8) and 15.3 months (6.6-not estimable [NE]), respectively. Median OS from initiation of first- and second-line treatment was 63.8 months (46.3-NE) and 22.4 months (12.4-NE), respectively. Conclusions For the treatment of advanced/metastatic MTC, no specific preference of sequencing systemic agents was observed in the first- and second-line settings. Considering the recent approval of selective RET inhibitors for patients with RET-mutant MTC, future research should investigate how treatment patterns evolve for these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13044-021-00119-9.
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Affiliation(s)
- Rohan Parikh
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Lisa M Hess
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Elizabeth Esterberg
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | | | - James A Kaye
- RTI Health Solutions, 307 Waverley Oaks Road, Waltham, MA, 02452, USA
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Bisrat A, Minda D, Assamnew B, Abebe B, Abegaz T. Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul's and Ayder Hospitals, Ethiopia. BMC Med Inform Decis Mak 2021; 21:306. [PMID: 34727948 PMCID: PMC8561912 DOI: 10.1186/s12911-021-01670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans. Methods A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented. Results St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system. Conclusion Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01670-z.
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Affiliation(s)
- Alemayehu Bisrat
- Library and Info Service Directorate, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Dagne Minda
- ICT Directorate, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bekalu Assamnew
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruk Abebe
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teshome Abegaz
- Health Informatics and Healthcare Innovation Department, School of Public Health, College of Health Sciences, Mekele University, Mekele, Ethiopia
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Bertsch I, Courtois R, Réveillère C, Pham T. [Is the use of patient records necessary to assess the risk of sexual, violent and general recidivism?]. Encephale 2021; 48:265-272. [PMID: 34728066 DOI: 10.1016/j.encep.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Sexual, violent and general recidivism risk scales are widely used in a number of countries. Their psychometric qualities are generally considered to be good. However, in practice they may vary in the quality of prediction of risk of sexual, violent and general recidivism, in particular because of the sources of the information collected. In France, the medical records of incarcerated patients are kept by health-care professionals. Although regulated, the content and quality of these records vary widely from one patient to another. The criminal justice system holds the criminal records of convicted and imprisoned persons. There is no set list of documents contained in these records. For caregivers and researchers, access to criminal records is difficult because of the confidentiality to which legal professionals are subject. The aim of our study was to investigate whether using medical files in addition to structured interviews can improve the assessment and management of the risks of sexual, violent and general recidivism. MATERIAL AND METHOD A total of 128 perpetrators of violence were assessed using three scales of risk of sexual, violent and general recidivism. Scores for the items of the scales were compared between (a) those that were based on medical records and an interview, and (b) those based only on an interview. RESULTS AND DISCUSSION First, differences in scores between the two groups (assessed through interview only, and assessed through interview and use of medical records) were observed on the RSVP, HCR-20 and LS/CMI scales. Secondly, most of the results indicate that the overall level of risk was perceived as lower when medical records were used, which would, indirectly, lead to a reduction in false positives when evaluating perpetrators of sexual violence. Thirdly, the point-by-point analysis shows that the use of information contained in the medical records reduces the weight of present and future factors (e.g. the physical and psychological stress of recent events), increases the weight of past factors (e.g. history of sexual violence), and can increase the weight of certain factors that can lead to more negative emotions in the assessor (e.g. deviance). These results can be explained by (i) the emotional functioning of the persons assessed (particularly defensive processes or memory difficulties), (ii) the attitude of the aggressor (particularly the presence of emotional and cognitive biases), (iii) the nature of the information (particularly "hot" cognitions or those leading to greater social desirability). The limitations of the study concern the relatively small number of participants, the environment in which the file was transmitted and the very heterogeneous and sometimes relatively incomplete composition of the files. CONCLUSION The use of information contained in medical files impacts the results of recidivism risk scales and restores a balance to the factors. In France, risk scales are currently being introduced, although their use is still limited in the health field. However, ethical use of these scales raises the issue of the homogenisation of the content of medical records and access to criminal records in order to enable future research to confirm whether the use of information provided in medical and criminal records can improve the quality of assessment and treatment of offenders.
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Affiliation(s)
- I Bertsch
- Département de psychologie, EE 1901 Qualipsy (qualité de vie et santé psychologique), université de Tours, 37000 Tours, France; Centre ressource pour les intervenants auprès des auteurs de violences sexuelles, centre Val-de-Loire, CHRU de Tours, avenue de la République, 37000 Tours, France; Département de psychologie légale, université de Mons-Hainaut, 7000 Mons, Belgique.
| | - R Courtois
- Département de psychologie, EE 1901 Qualipsy (qualité de vie et santé psychologique), université de Tours, 37000 Tours, France; Centre ressource pour les intervenants auprès des auteurs de violences sexuelles, centre Val-de-Loire, CHRU de Tours, avenue de la République, 37000 Tours, France
| | - C Réveillère
- Département de psychologie, EE 1901 Qualipsy (qualité de vie et santé psychologique), université de Tours, 37000 Tours, France
| | - T Pham
- CRDS, centre de recherche en défense sociale, 7500 Tournai, Belgique; Département de psychologie légale, université de Mons-Hainaut, 7000 Mons, Belgique
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Cui J, Zhu H, Deng H, Chen Z, Liu D. FeARH: Federated machine learning with anonymous random hybridization on electronic medical records. J Biomed Inform 2021; 117:103735. [PMID: 33711540 DOI: 10.1016/j.jbi.2021.103735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/09/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Electrical medical records are restricted and difficult to centralize for machine learning model training due to privacy and regulatory issues. One solution is to train models in a distributed manner that involves many parties in the process. However, sometimes certain parties are not trustable, and in this project, we aim to propose an alternative method to traditional federated learning with central analyzer in order to conduct training in a situation without a trustable central analyzer. The proposed algorithm is called "federated machine learning with anonymous random hybridization (abbreviated as 'FeARH')", using mainly hybridization algorithm to degenerate the integration of connections between medical record data and models' parameters by adding randomization into the parameter sets shared to other parties. Based on our experiment, our new algorithm has similar AUCROC and AUCPR results compared with machine learning in a centralized manner and original federated machine learning.
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Affiliation(s)
- Jianfei Cui
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90007, United States
| | - He Zhu
- The Hong Kong Polytechnic University, Hong Kong
| | - Hao Deng
- Harvard Medical School, Boston, MA 02115, United States; Massachusetts General Hospital, Boston, MA 02115, United States
| | - Ziwei Chen
- Beijing Jiaotong University, Beijing, China.
| | - Dianbo Liu
- Harvard Medical School, Boston, MA 02115, United States; Massachusetts General Hospital, Boston, MA 02115, United States; The Broad institute of MIT and Harvard, Cambridge, MA 02115, United States; Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA 02139, United States.
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Abstract
BACKGROUND Padua linear model is widely used for the risk assessment of venous thromboembolism (VTE), a common but preventable complication for inpatients. However, genetic and environmental differences between Western and Chinese population limit the validity of Padua model in Chinese patients. Medical records which contain rich information about disease progression, are useful in mining new risk factors related to Chinese VTE patients. Furthermore, machine learning (ML) methods provide new opportunities to build precise risk prediction model by automatic selection of risk factors based on original medical records. METHODS Medical records of 3,106 inpatients including 224 VTE patients were collected and various types of ontologies were integrated to parse unstructured text. A workflow of ontology-based VTE risk prediction model, that combines natural language processing (NLP) and machine learning (ML) technologies, was proposed. Firstly ontology terms were extracted from medical records, then sorted according to their calculated weights. Next importance of each term in the unit of section was evaluated and finally a ML model was built based on a subset of terms. Four ML methods were tested, and the best model was decided by comparing area under the receiver operating characteristic curve (AUROC). RESULTS Medical records were first split into different sections and subsequently, terms from each section were sorted by their weights calculated by multiple types of information. Greedy selection algorithm was used to obtain significant sections and terms. Top terms in each section were selected to construct patients' distributed representations by word embedding technique. Using top 300 terms of two important sections, namely the 'Progress Note' section and 'Admitting Diagnosis' section, the model showed relatively better predictive performance. Then ML model which utilizes a subset of terms from two sections, about 110 terms, achieved the best AUC score, of 0.973 ± 0.006, which was significantly better compared to the Padua's performance of 0.791 ± 0.022. Terms found by the model showed their potential to help clinicians explore new risk factors. CONCLUSIONS In this study, a new VTE risk assessment model based on ontologies extraction from raw medical records is developed and its performance is verified on real clinical dataset. Results of selected terms can help clinicians to discover meaningful risk factors.
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Affiliation(s)
- Yuqing Yang
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Xin Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China
- Peking Union Medical College, Beijing, China
| | - Yu Huang
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Ning Chen
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China
| | - Juhong Shi
- Peking Union Medical College, Beijing, China.
- Department of Respiration, Peking Union Medical College Hospital, Beijing, China.
| | - Ting Chen
- Department of Computer Science and Technology, Institute for Artificial Intelligence, State Key Lab of Intelligent Technology and Systems, Tsinghua University, Beijing, 100084, China.
- Tsinghua-Fuzhou Institute of Digital Technology, Beijing National Research Center for Information Science and Technology, Tsinghua University, Beijing, 100084, China.
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Khanji C, Schnitzer ME, Bareil C, Perreault S, Lalonde L. Concordance of care processes between medical records and patient self-administered questionnaires. BMC Fam Pract 2019; 20:92. [PMID: 31269902 PMCID: PMC6607524 DOI: 10.1186/s12875-019-0979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022]
Abstract
Background Despite the increasing use of medical records to measure quality of care, studies have shown that their validity is suboptimal. The objective of this study is to assess the concordance of cardiovascular care processes evaluated through medical record review and patient self-administered questionnaires (SAQs) using ten quality indicators (TRANSIT indicators). These indicators were developed as part of a participatory research program (TRANSIT study) dedicated to TRANSforming InTerprofessional clinical practices to improve cardiovascular disease (CVD) prevention in primary care. Methods For every patient participating in the TRANSIT study, the compliance to each indicator (individual scores) as well as the mean compliance to all indicators of a category (subscale scores) and to the complete set of ten indicators (overall scale score) were established. Concordance between results obtained using medical records and patient SAQs was assessed by prevalence-adjusted bias-adjusted kappa (PABAK) coefficients as well as intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI). Generalized linear mixed models (GLMM) were used to identify patients’ sociodemographic and clinical characteristics associated with agreement between the two data sources. Results The TRANSIT study was conducted in a primary care setting among patients (n = 759) with multimorbidity, at moderate (16%) and high risk (83%) of cardiovascular diseases. Quality of care, as measured by the TRANSIT indicators, varied substantially between medical records and patient SAQ. Concordance between the two data sources, as measured by ICCs (95% CI), was poor for the subscale (0.18 [0.08–0.27] to 0.46 [0.40–0.52]) and overall (0.46 [0.40–0.53]) compliance scale scores. GLMM showed that agreement was not affected by patients’ characteristics. Conclusions In quality improvement strategies, researchers must acknowledge that care processes may not be consistently recorded in medical records. They must also be aware that the evaluation of the quality of care may vary depending on the source of information, the clinician responsible of documenting the interventions, and the domain of care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0979-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia Khanji
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Mireille E Schnitzer
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Céline Bareil
- HEC Montréal, University of Montreal, 3000 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T2A7, Canada
| | - Sylvie Perreault
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada.,Sanofi Aventis Endowment Chair in Drug Utilization, Montreal, Canada
| | - Lyne Lalonde
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada. .,Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Montreal, Canada.
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Noble N, Paul C, Walsh J, Wyndham K, Wilson S, Stewart J. Concordance between self-report and medical records of preventive healthcare delivery among a sample of disadvantaged patients from four aboriginal community controlled health services. BMC Health Serv Res 2019; 19:111. [PMID: 30736763 PMCID: PMC6368754 DOI: 10.1186/s12913-019-3930-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to explore, among a sample of patients attending one of four Aboriginal Health Services (ACCHSs), the degree of concordance between self-report and medical records for whether screening for key healthcare items had ever been undertaken, or had been undertaken within the recommended timeframe. METHODS Across the four ACCHSs, a convenience sample of 109 patients was recruited. Patients completed a self-report computer survey assessing when they last had preventive care items undertaken at the service. ACCHS staff completed a medical record audit for matching items. The degree of concordance (i.e. the percentage of cases in which self-reports matched responses from the medical record) was calculated. RESULTS Concordance was relatively high for items including assessment of Body Mass Index and blood pressure, but was substantially lower for items including assessment of waist circumference, alcohol intake, physical activity, and diet. CONCLUSIONS Reliance on either patient self-report or medical record data for assessing the level of preventive care service delivery by ACCHSs requires caution. Efforts to improve documentation of some preventive care delivery in medical records are needed. These findings are likely to also apply to patients in other general practice settings.
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Affiliation(s)
- Natasha Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Christine Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Justin Walsh
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Kylie Wyndham
- Bulgarr Ngaru Medical Aboriginal Corporation, Richmond Valley Clinic, 153 - 157 Canterbury St, Casino, NSW, 2470, Australia
| | - Sue Wilson
- Durri Aboriginal Corporation Medical Service, 15-19 York Lane, Kempsey, NSW, 2440, Australia
| | - Jessica Stewart
- NSW Department of Family & Community Services- Business Services, 219-241 Cleveland Street, Redfern, NSW, 2016, Australia
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Moscatelli M, Manconi A, Pessina M, Fellegara G, Rampoldi S, Milanesi L, Casasco A, Gnocchi M. An infrastructure for precision medicine through analysis of big data. BMC Bioinformatics 2018; 19:351. [PMID: 30367571 PMCID: PMC6191972 DOI: 10.1186/s12859-018-2300-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nowadays, the increasing availability of omics data, due to both the advancements in the acquisition of molecular biology results and in systems biology simulation technologies, provides the bases for precision medicine. Success in precision medicine depends on the access to healthcare and biomedical data. To this end, the digitization of all clinical exams and medical records is becoming a standard in hospitals. The digitization is essential to collect, share, and aggregate large volumes of heterogeneous data to support the discovery of hidden patterns with the aim to define predictive models for biomedical purposes. Patients' data sharing is a critical process. In fact, it raises ethical, social, legal, and technological issues that must be properly addressed. RESULTS In this work, we present an infrastructure devised to deal with the integration of large volumes of heterogeneous biological data. The infrastructure was applied to the data collected between 2010-2016 in one of the major diagnostic analysis laboratories in Italy. Data from three different platforms were collected (i.e., laboratory exams, pathological anatomy exams, biopsy exams). The infrastructure has been designed to allow the extraction and aggregation of both unstructured and semi-structured data. Data are properly treated to ensure data security and privacy. Specialized algorithms have also been implemented to process the aggregated information with the aim to obtain a precise historical analysis of the clinical activities of one or more patients. Moreover, three Bayesian classifiers have been developed to analyze examinations reported as free text. Experimental results show that the classifiers exhibit a good accuracy when used to analyze sentences related to the sample location, diseases presence and status of the illnesses. CONCLUSIONS The infrastructure allows the integration of multiple and heterogeneous sources of anonymized data from the different clinical platforms. Both unstructured and semi-structured data are processed to obtain a precise historical analysis of the clinical activities of one or more patients. Data aggregation allows to perform a series of statistical assessments required to answer complex questions that can be used in a variety of fields, such as predictive and precision medicine. In particular, studying the clinical history of patients that have developed similar pathologies can help to predict or individuate markers able to allow an early diagnosis of possible illnesses.
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Affiliation(s)
- Marco Moscatelli
- Institute for Biomedical Technologies – National Research Council (CNR-ITB), via F.lli Cervi 93, Segrate, 20090 MI Italy
| | - Andrea Manconi
- Institute for Biomedical Technologies – National Research Council (CNR-ITB), via F.lli Cervi 93, Segrate, 20090 MI Italy
| | - Mauro Pessina
- Centro Diagnostico Italiano, Via Simone Saint Bon 20, Milan, 20147 Italy
| | - Giovanni Fellegara
- Centro Diagnostico Italiano, Via Simone Saint Bon 20, Milan, 20147 Italy
| | - Stefano Rampoldi
- Centro Diagnostico Italiano, Via Simone Saint Bon 20, Milan, 20147 Italy
| | - Luciano Milanesi
- Institute for Biomedical Technologies – National Research Council (CNR-ITB), via F.lli Cervi 93, Segrate, 20090 MI Italy
| | - Andrea Casasco
- Centro Diagnostico Italiano, Via Simone Saint Bon 20, Milan, 20147 Italy
| | - Matteo Gnocchi
- Institute for Biomedical Technologies – National Research Council (CNR-ITB), via F.lli Cervi 93, Segrate, 20090 MI Italy
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Chua SC, Treadwell EL, Gidaszewski B, Gibbs E, Kirby A, Khajehei M. Validation of the accuracy of postpartum haemorrhage data in the ObstetriX database: A retrospective cohort study. Int J Med Inform 2018; 120:42-9. [PMID: 30409345 DOI: 10.1016/j.ijmedinf.2018.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Data related to postpartum haemorrhage (PPH) are important clinical parameters which can be applied to all places of birth, and their recording can be missed by busy clinicians providing critical care to women. We compared the accuracy of electronic ObstetriX records to the paper-based medical records of the women who sustained PPH. METHODS In this retrospective cohort study over a period of one month, 363 electronic records were compared to the paper-based medical records. The volume of blood loss for each patient and interventions for PPH were compared across birth unit, operating theatre and postpartum ward. The kappa statistic for agreement between the two types of recording methods was calculated. RESULTS There was substantial agreement between the ObstetriX records and medical records for the volume of blood loss at birth (kappa = 0.74), but poor agreement between records for the cumulative total volume of blood loss (kappa = 0.18). More women who experienced PPH and delivered in the operating theatre had errors in their ObstetriX records compared to women who had PPH with births in the birth unit (50% vs 16%; n = 73, P = 0.005). Interventions for PPH were found to be poorly recorded in ObstetriX, with 84% (n = 64/76) of women who experienced PPH having none of the interventions they received recorded. CONCLUSIONS The ObstetriX database was not a generally reliable source of data relating to PPH. However, some data were recorded reliably, in particular, the volume of blood loss at birth.
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McFall A, Peake SL, Williams PJ. Weight and height documentation: Does ICU measure up? Aust Crit Care 2018; 32:314-318. [PMID: 30005937 DOI: 10.1016/j.aucc.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Reliable assessment and documentation of weight and height are essential for the accurate delivery of many critical care interventions. METHODS We conducted a 3-month retrospective, cross-sectional, single-centre audit to determine the prevalence of weight and height documentation in the clinical records of patients admitted to the intensive care unit (ICU) for the period from 3 months prior to hospital admission up to hospital discharge. RESULTS One hundred forty-one index ICU admissions were identified from October-December 2015 with 138 medical records available for analysis. Median (interquartile range) age was 64.5 (50.8-75.3) years, the majority were male (60.9%, 84/138), and the ICU admission Acute Physiology and Chronic Health Evaluation II score was 19.0 (14.0-25.0). Overall, weight and height were recorded in 90 (65.2%) and 63 (45.6%) patients, respectively. For elective postoperative admissions (n = 20), weight and height were recorded in 20 (100%) and 19 (95%) patients. For emergency medical and surgical admissions, 70 (59.3%) and 44 (37.2%) patients had weight and height recorded in both the 3-month period prior to hospital admission and the in-hospital period. A moderate, positive correlation was shown, r = 0.55, P < 0.001, with a longer hospital length of stay being associated with a greater number of weight and height records for each patient. In the emergency patient cohort, 81.7% (n = 215/263) of weight- and/or height-based interventions occurred before or during the ICU admission, of which 69.9% (n = 184/263) required consideration of ideal body weight. CONCLUSION Measurement and medical record documentation of weight and height is infrequently performed in ICU patients. Given the clinical requirement for accurate measurement and documentation, further research to understand the barriers to perform and document this important process of care is necessary.
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Affiliation(s)
- Alan McFall
- The Queen Elizabeth Hospital, Department of Intensive Care Medicine, 28 Woodville Road, Woodville South, 5011, South Australia, Australia.
| | - Sandra L Peake
- The Queen Elizabeth Hospital, Department of Intensive Care Medicine, 28 Woodville Road, Woodville South, 5011, South Australia, Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide, 5000, South Australia, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Patrica J Williams
- The Queen Elizabeth Hospital, Department of Intensive Care Medicine, 28 Woodville Road, Woodville South, 5011, South Australia, Australia; School of Medicine, University of Adelaide, North Terrace, Adelaide, 5000, South Australia, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
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15
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Dufour É, Duhoux A, Contandriopoulos D. Reliability of a Canadian database for primary care nursing services' clinical and administrative data. Int J Med Inform 2018; 117:1-5. [PMID: 30032957 DOI: 10.1016/j.ijmedinf.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/04/2018] [Accepted: 05/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of electronic clinical and administrative data can be an advantageous source of information for assessing nursing performance in primary care. In Québec (Canada), the I-CLSC electronic database could be used to measure performance indicators. However, little is known about the reliability of the data contained in this database. The objective of this study was to assess the reliability of the clinical and administrative data contained in the I-CLSC electronic database based on the data entered in medical records. METHODS We used a longitudinal design for this study. A sample of 100 patients who had experienced 107 episodes of wound care were randomly selected from all patients who had two or more consultations during the year 2015. The paper records were used as reference. We collected data regarding eight nursing sensitive indicators from both sources. We assessed the concordance between the electronic data and the paper records by measuring inter-rater agreement. RESULTS Six of the eight indicators showed a percentage agreement ≥ 85%, and kappa scores between 0.7 and 1.00 (p < 0.001), indicating high to perfect levels of agreement between the two data sources. Two indicators presented fair kappa scores. CONCLUSION This database provides reliable data relating to the organization of care but shows lower reliability for specific acts performed by nurses in primary care. This existing database can be used to assess, manage and improve certain dimensions of nursing performance in primary care.
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Affiliation(s)
- Émilie Dufour
- Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Campus, Montréal, QC, H3C 3J7, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Campus, Montréal, QC, H3C 3J7, Canada; CR-CSIS (Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé), Université de Sherbrooke, Longueuil Campus, Longueuil, QC, J4K 0A8, Canada
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Tran HT, Nguyen HP, Walker SM, Hill PS, Rao C. Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam. BMC Med Res Methodol 2018; 18:43. [PMID: 29776431 PMCID: PMC5960129 DOI: 10.1186/s12874-018-0497-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. METHODS This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). RESULTS The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. CONCLUSIONS Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.
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Affiliation(s)
- Hong Thi Tran
- Faculty of Fundamental Sciences, Hanoi University of Public Health, Hanoi, Vietnam. .,School of Public Health, University of Queensland, Brisbane, Australia.
| | - Hoa Phuong Nguyen
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | - Sue M Walker
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,National Centre for Health Information Research and Training, Queensland University of Technology, Brisbane, Australia
| | - Peter S Hill
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Chalapati Rao
- Department of Global Health, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Ishii T, Tachikawa H, Shiratori Y, Hori T, Aiba M, Kuga K, Arai T. What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records. Asian J Psychiatr 2018; 32:67-72. [PMID: 29216609 DOI: 10.1016/j.ajp.2017.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
AIMS University students that suffer from mental disorders seem to have difficulty graduating. Therefore, we investigated risk and protective factors of dropping out with the aim of improving such students' academic outcomes. METHODS First, we statistically compared the academic outcomes of 203 undergraduate students who received treatment in the Department of Psychiatry of the Tsukuba University Health Center to those of matched controls. Second, clinical factors of 370 mentally ill students were statistically compared between the dropout and graduate groups. RESULTS Mentally ill students experienced significantly greater difficulties graduating. Furthermore, the ratio of females and the year of study at initial consultation were significantly lower in the dropout group. However, duration of illness, social withdrawal, temporary leaves of absence, percentage of diagnosis of F2, history of truancy, CGI-S/GI score, number of suicide attempts, visits to us, family consultations with us and grade repeating were longer or greater in the dropout group. Ultimately, the number of suicide attempts, CGI-S score, social withdrawal and leaves of absence were significantly associated with dropping out. Moreover, duration of social withdrawal and leaves of absence were significantly correlated with CGI-GI score. CONCLUSION We found that the number of suicide attempts, CGI-S score, social withdrawal and extended enrollment were risk factors for dropping out, while the therapeutic effect seemed to be a protective factor. As risk factors involved states of social maladjustment, it is necessary not only to treat mental disorders, but also to provide assistance such as educational and individual support for daily living.
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Affiliation(s)
- Terumi Ishii
- Department of Psychiatry, Tsukuba University Health Center, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan; Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan.
| | - Hirokazu Tachikawa
- Department of Psychiatry, Tsukuba University Health Center, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan; Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Yuki Shiratori
- Department of Psychiatry, Tsukuba University Health Center, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan; Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Takafumi Hori
- Ibaraki Prefectural Medical Center of Psychiatry, 654 Asahimachi, Kasama, Ibaraki, 309-1717, Japan
| | - Miyuki Aiba
- Institute of Human Sciences, Toyo University, 2100 Kujirai, Kawagoe-shi, Saitama, 350-8585, Japan
| | - Keisuke Kuga
- Tsukuba University Health Center, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan
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Poldervaart JM, van Melle MA, Willemse S, de Wit NJ, Zwart DLM. In-hospital prescription changes and documentation in the medical records of the primary care provider: results from a medical record review study. BMC Health Serv Res 2017; 17:792. [PMID: 29187185 PMCID: PMC5707815 DOI: 10.1186/s12913-017-2738-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing number of transitions due to substitution of care of more complex patients urges
insight in and improvement of transitional medication safety. While lack of documentation of prescription changes and/or lack of information exchange between settings likely cause adverse drug events, frequency of occurrence of these causes is not clear. Therefore, we aimed at determining the frequency of in-hospital patients’ prescription changes that are not or incorrectly documented in their primary care provider’s (PCP) medical record. METHODS A medical record review study was performed in a database linking patients’ medical records of hospital
and PCP. A random sample (n = 600) was drawn from all 1399 patients who were registered at a participating
primary care practice as well as the gastroenterology or cardiology department in 2013 of the University Medical Center Utrecht, the Netherlands. Outcomes were the number of in-hospital prescription changes that was not or incorrectly documented in the medical record of the PCP, and timeliness of documentation. RESULTS Records of 390 patients included one or more primary-secondary care transitions; in total we identified
1511 transitions. During these transitions, 408 in-hospital prescription changes were made, of which 31% was not or incorrectly documented in the medical record of the PCP within the next 3 months. In case changes were documented, the median number of days between hospital visit and documentation was 3 (IQR 0–18). CONCLUSIONS One third of in-hospital prescription changes was not or incorrectly documented in the PCP’s record,
which likely puts patients at risk of adverse drug events after hospital visits. Such flawed reliability of a routine care process is unacceptable and warrants improvement and close monitoring.
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Affiliation(s)
- Judith M Poldervaart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands.
| | - Marije A van Melle
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
| | - Sanne Willemse
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary care, University Medical Center Utrecht, Utrecht University, Str. 6.101, PO box 85500, 3508AB, Utrecht, the Netherlands
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Chérrez-Ojeda I, Robles-Velasco K, Bedoya-Riofrio P, Schmid-Grendelmeier P, Chérrez S, Colbatzky F, Cardona R, Barberan-Torres P, Calero E, Calderón JC, Larco JI, Chérrez A. [Is it possible for chronic urticaria diagnostic approach to be simplified? A clinical data checklist]. ACTA ACUST UNITED AC 2017; 64:309-326. [PMID: 29046029 DOI: 10.29262/ram.v64i3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Existing clinical guidelines do not offer an efficient alternative for the collection of data on relevant clinical traits during history and physical of the patient with chronic urticaria. OBJECTIVE Our aim was to provide a clinical data checklist together with its guide to allow for thorough information to be obtained and for a physical exam that identifies the main features and triggering factors of the disease to be carried out. METHODS A search was conducted for relevant literature on chronic urticaria in Medline, the Cochrane library and PubMed. RESULTS We developed an easy-to-use clinical data checklist with its corresponding clinical guide, comprised by 42 items based on two components: essential clues for history taking and chronic urticaria diagnosis (typical symptoms according to subgroups, etiology and laboratory results). Some components are the time of disease onset, wheals' duration, shape, size, color and distribution, associated angioedema, atopy, triggering factors and others. CONCLUSION The clinical data checklist and its guide constitute a tool to focus, guide and save time in medical consultation, with the main purpose to aid physicians in providing better diagnosis and management of the disease.
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Sayyah-Melli M, Nikravan Mofrad M, Amini A, Piri Z, Ghojazadeh M, Rahmani V. The Effect of Medical Recording Training on Quantity and Quality of Recording in Gynecology Residents of Tabriz University of Medical Sciences. J Caring Sci 2017; 6:281-292. [PMID: 28971078 PMCID: PMC5618952 DOI: 10.15171/jcs.2017.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 01/22/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction: Medical records contain valuable information
about a patient's medical history and treatment. Patient safety is one of the most
important dimensions of health care quality assurance and performance improvement.
Completing the process of documentation is necessary to continue patient care and
continuous quality improvement of basic services. The aim of the present study was to
evaluate the effect of medical recording education on the quantity and quality of
recording in gynecology residents of Tabriz University of Medical Sciences. Methods: This study is a quasi-experimental study and was
conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through
fourth year gynecologic residents of Tabriz University of Medical Sciences who were
willing to participate in the study were included by census sampling and participated in
training workshop. Three evaluators reviewed the residents’ records before and after
training course by a checklist. Statistical analyses were performed using SPSS 13
software. P-values less than 0.05 were considered statistically significant. Results: The results showed that before the intervention,
there were significant differences in the quantity of information status among the
evaluators and no significant difference was observed in the recording of qualitative
status. After the workshop, among the 3 evaluators, there were also significant
differences in the quantity of data recording status; however, no significant change was
observed in recording of qualitative status. Conclusion: The study findings revealed that a sectional
training course of correct and standardized medical records has no effect on reforming the
process of recording.
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Affiliation(s)
- Manizheh Sayyah-Melli
- Departement of Obstetrics and Gynecology, Shahid Beheshti University of Medical Sciences, School of Medical Education, Tehran, Iran.,Research Center of Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Malahat Nikravan Mofrad
- Departement of Nursing, School of Nursing & Midwifery, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolghasem Amini
- Department and Center for Educational Research and Development (EDC), Tabriz University of Medical Science, Tabriz, Iran
| | - Zakieh Piri
- Department of Medical Records, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center of Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahideh Rahmani
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Machado IK, Luz PM, Lake JE, Castro R, Velasque L, Clark JL, Veloso VG, Grinsztejn B, De Boni RB. Substance use among HIV-infected patients in Rio de Janeiro, Brazil: Agreement between medical records and the ASSIST questionnaire. Drug Alcohol Depend 2017; 178:115-8. [PMID: 28646713 DOI: 10.1016/j.drugalcdep.2017.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Substance use assessment is a challenge in busy clinical settings that may adversely affect HIV-infected persons. This study aimed to evaluate agreement between the medical chart and a standardized substance use screening questionnaire. METHODS Of adults (n=1050) in HIV care in Rio de Janeiro who completed the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), we randomly selected 200 participants for medical chart review. Lifetime use of tobacco, alcohol, marijuana, and cocaine agreement between the medical record and ASSIST was evaluated using Kappa statistics. Sensitivity and specificity of chart information were also calculated. RESULTS The median age was 42.4 years, 60.3% were male and 49.5% were white. Prevalence of lifetime use reported in ASSIST was 55.3% (tobacco), 79.4% (alcohol), 23.1% (marijuana), and 20.7% (cocaine). Any information on lifetime use was found in the medical chart for tobacco (n=180, 90.5%), alcohol (n=183, 92.0%), marijuana (n=143, 71.8%), and cocaine (n=151, 75.9%). The Kappa statistic, sensitivity and specificity of the medical chart accurately identifying lifetime substance users per ASSIST were respectively 0.60, 0.71, and 0.91 for tobacco; 0.22, 0.75, and 0.51 for alcohol; 0.58, 0.51, and 0.98 for marijuana; and 0.73, 0.75, and 0.96 for cocaine. CONCLUSION Considering inaccuracies in the medical chart, the implementation of brief, standardized substance use screening is recommended in HIV care settings.
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Vermeir P, Degroote S, Vandijck D, Van Tiggelen H, Peleman R, Verhaeghe R, Mariman A, Vogelaers D. The patient perspective on the effects of medical record accessibility: a systematic review. Acta Clin Belg 2017; 72:186-194. [PMID: 28056665 DOI: 10.1080/17843286.2016.1275375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. RESULTS Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. CONCLUSION From the patient perspective medical record accessibility contributes to co-management of personal health care.
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Affiliation(s)
- Peter Vermeir
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Sophie Degroote
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique Vandijck
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of Patient Safety, Health Economics & Healthcare Innovation, Hasselt University, Agoralaan (building D), 3590 Diepenbeek, Belgium
| | - Hanne Van Tiggelen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Renaat Peleman
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Rik Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Le L, Schairer C, Hablas A, Meza J, Watanabe-Galloway S, Ramadan M, Merajver SD, Seifeldin IA, Soliman AS. Reliability of medical records in diagnosing inflammatory breast cancer in Egypt. BMC Res Notes 2017; 10:126. [PMID: 28302157 PMCID: PMC5356360 DOI: 10.1186/s13104-017-2433-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 02/16/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is a rare, aggressive breast cancer diagnosed clinically by the presence of diffuse erythema, peau d'orange, and edema that arise quickly in the affected breast. This study evaluated the validity of medical records in Gharbiah, Egypt in identifying clinical signs/symptoms of IBC. For 34 IBC cases enrolled in a case-control study at the Gharbiah Cancer Society and Tanta Cancer Center, Egypt (2009-2010), we compared signs/symptoms of IBC noted in medical records to those recorded on a standardized form at the time of IBC diagnosis by clinicians participating in the case-control study. We calculated the sensitivity and specificity of medical records as compared to the case-control study for recording these signs/symptoms. We also performed McNemar's tests. RESULTS In the case-control study, 32 (94.1%) IBC cases presented with peau d'orange, 30 (88.2%) with erythema, and 31 (91.2%) with edema. The sensitivities of the medical records as compared to the case-control study were 0.8, 0.5, and 0.2 for peau d'orange, erythema, and edema, respectively. Corresponding specificities were 1.0, 0.5, and 1.0. p values for McNemar's test were <0.05 for all signs. Medical records had data on the extent and duration of signs for at most 27% of cases for which this information was recorded in the case-control study. Twenty-three of the 34 cases (67.6%) had confirmed diagnosis of IBC in their medical records. CONCLUSION Medical records lacked information on signs/symptoms of IBC, especially erythema and edema, when compared to the case-control study. Deficient medical records could have implications for diagnosis and treatment of IBC and proper documentation of cases in cancer registries.
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Affiliation(s)
- Lynne Le
- University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Catherine Schairer
- National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
| | | | - Jane Meza
- University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shinobu Watanabe-Galloway
- University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198, USA
| | | | - Sofia D Merajver
- University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | | | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
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25
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Blakey JD, Price DB, Pizzichini E, Popov TA, Dimitrov BD, Postma DS, Josephs LK, Kaplan A, Papi A, Kerkhof M, Hillyer EV, Chisholm A, Thomas M. Identifying Risk of Future Asthma Attacks Using UK Medical Record Data: A Respiratory Effectiveness Group Initiative. J Allergy Clin Immunol Pract 2016; 5:1015-1024.e8. [PMID: 28017629 DOI: 10.1016/j.jaip.2016.11.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/13/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors. OBJECTIVE We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent attacks. METHODS We analyzed anonymized, longitudinal medical records of 118,981 patients with actively treated asthma (ages 12-80 years) and 3 or more years of data. Potential risk factors during 1 baseline year were evaluated using univariable (simple) logistic regression for outcomes of 2 or more and 4 or more attacks during the following 2-year period. Predictors with significant univariable association (P < .05) were entered into multiple logistic regression analysis with backward stepwise selection of the model including all significant independent predictors. The predictive accuracy of the multivariable models was assessed. RESULTS Independent predictors associated with future attacks included baseline-year markers of attacks (acute oral corticosteroid courses, emergency visits), more frequent reliever use and health care utilization, worse lung function, current smoking, blood eosinophilia, rhinitis, nasal polyps, eczema, gastroesophageal reflux disease, obesity, older age, and being female. The number of oral corticosteroid courses had the strongest association. The final cross-validated models incorporated 19 and 16 risk factors for 2 or more and 4 or more attacks over 2 years, respectively, with areas under the curve of 0.785 (95% CI, 0.780-0.789) and 0.867 (95% CI, 0.860-0.873), respectively. CONCLUSIONS Routinely collected data could be used proactively via automated searches to identify individuals at risk of recurrent asthma attacks. Further research is needed to assess the impact of such knowledge on clinical prognosis.
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Affiliation(s)
- John D Blakey
- Clinical Sciences, Liverpool School of Tropical Medicine, and Respiratory Medicine, Royal Liverpool Hospital, Liverpool, United Kingdom.
| | - David B Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom; Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Emilio Pizzichini
- NUPAIVA (Asthma Research Centre), University Hospital, Federal University of Santa Catarina, Florianуpolis, Santa Catarina, Brazil
| | | | - Borislav D Dimitrov
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, United Kingdom
| | - Dirkje S Postma
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lynn K Josephs
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Alberto Papi
- Department of Medicine, University of Ferrara, Ferrara, Italy
| | - Marjan Kerkhof
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | | | | | - Mike Thomas
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, United Kingdom
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Hamood R, Hamood H, Merhasin I, Keinan-Boker L. A feasibility study to assess the validity of administrative data sources and self-reported information of breast cancer survivors. Isr J Health Policy Res 2016; 5:50. [PMID: 27980719 PMCID: PMC5131548 DOI: 10.1186/s13584-016-0111-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/10/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer survivorship has increasingly become the focus of research due to progress in early detection and advancements in the therapeutic approach, but high-quality information sources for outcomes, potential confounders and personal characteristics present a challenge. Few studies have collected breast cancer care data from mixed data sources and validated them, and to the best of our knowledge, none so far have been conducted in Israel, where National Health Insurance Law assures universal health care, delivered through four health care funds with computerized administrative, pharmaceutical and medical databases. This validation study is aimed to assess the accuracy and completeness of information on cancer care and health outcomes using several research tools, before embarking on a full-scale study aimed to evaluate the long-term treatment-related health adverse outcomes in a cohort of breast cancer survivors. METHODS One hundred twenty randomly sampled female patients diagnosed with primary breast cancer in years 2000-2010 in northern Israel, who are members of the "Leumit" healthcare fund, were included. Data sources included "Leumit" medical records, the National Cancer Registry and a self-report questionnaire. The questionnaire was completed by 99 % of the women contacted. The accuracy of the information regarding cancer care was assessed with the reference standard set as one of the research tools, varying per the characteristic being under investigation. For example: health outcomes and medical history were validated against "Leumit" medical records, while construct validity of the self-reported questionnaire served to assess the prevalence of chronic pain. Agreement, predictive values, correlations, and internal consistency were calculated. Logistic regression models were constructed to assess potential predictors of correct responses. RESULTS The overall level of agreement (Kappa) was almost perfect for demographics and outcomes, above 0.8 for treatments and chronic pain, while only fair to moderate for most of the self-reported medical history. Correct responses of medical history were associated with Jewish ethnicity, recency of breast cancer diagnosis, and family history of cardiovascular disease. The internal consistency of the quality-of-life scale was above 0.9. CONCLUSION In the absence of a national registry for cancer care, a mixed methodology for data collection is the most complete source. TRIAL REGISTRATION Trial registration number Not available. This is an observational study with prospective data collection and no intervention; therefore, trial registration number is not required.
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Affiliation(s)
- Rola Hamood
- School of Public Health, University of Haifa, Haifa, Israel
| | - Hatem Hamood
- Leumit Health Services, Haharoshet 17, Karmiel, Israel
| | | | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
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Abstract
For centuries, healthcare has been a basic service provided by many governments to their citizens. Over the past few decades, we have witnessed a significant transformation in the quality of healthcare services provided by healthcare organizations and professionals. Recent advances have led to the emergence of Electronic Health (E-health), largely made possible by the massive deployment and adoption of information and communication technologies (ICTs). However, cybercriminals and attackers are exploiting vulnerabilities associated primarily with ICTs, causing data breaches of patients' confidential digital health information records. Here, we review recent security attacks reported for E-healthcare and discuss the solutions proposed to mitigate them. We also identify security challenges that must be addressed by E-health system designers and implementers in the future, to respond to threats that could arise as E-health systems become integrated with technologies such as cloud computing, the Internet of Things, and smart cities.
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Affiliation(s)
- Sherali Zeadally
- College of Communication and Information, University of Kentucky, Lexington, KY, 40506-2299, USA.
| | - Jesús Téllez Isaac
- Computer Science Department (Facyt), Universidad de Carabobo, Sector Bárbula, Valencia, Venezuela
| | - Zubair Baig
- School of Science and Security Research Institute, Edith Cowan University, Perth, 6027, Australia
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28
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Nazareth T, Friedman HS, Navaratnam P, Herriott DA, Ko JJ, Barr P, Sasane R. Persistency, medication prescribing patterns, and medical resource use associated with multiple sclerosis patients receiving oral disease-modifying therapies: a retrospective medical record review. BMC Neurol 2016; 16:187. [PMID: 27683214 PMCID: PMC5041514 DOI: 10.1186/s12883-016-0698-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 09/12/2016] [Indexed: 12/24/2022] Open
Abstract
Background In the US, the approved multiple sclerosis (MS) oral disease-modifying therapies (ODMTs) are fingolimod (FTY), teriflunomide (TFN), and dimethyl fumarate (DMF). FTY and TFN are recommended with once-daily doses with no up-titration, whereas DMF treatment is recommended twice-daily (BID) and is initiated with a 7-day starter dose of 120 mg BID before up-titration to the maintenance dose of 240 mg BID. Limited information exists regarding real-world ODMT prescribing patterns to aid physician/patient decision-making. Methods Eligible patients for this retrospective medical record review were ≥18 years, had one visit related to ODMT initiation (index visit), and ≥1 visit within 12 months before and after the index visit. Primary objectives were to assess post-index ODMT persistency (i.e., discontinuation), prescribing patterns (medication switching, dose up-titrations, dose reduction, re-starts, and add-ons) and medical resource utilization (office-visits, MRI procedures, and mobility indicators) at distinct time windows of 3, 6, 9, and 12 months. Chi-square or Wilcoxon Rank Sum tests were used for 3-way ODMT group comparisons. Results Medical records of 293 MS-diagnosed patients using ODMTs were abstracted from 19 US-based neurology clinics between December 31, 2010 and June 30, 2014 (FTY: 101; DMF: 133; TFN: 59). Persistency rates among ODMT groups were similar. MS-related medication switching, dose reduction, re-starts, and add-ons were infrequently observed and were similar across ODMT groups. Of DMF patients with a confirmed starting dose of 120 mg BID with ≥12 months follow-up (n = 26), the percentage who were prescribed dose up-titrations to the recommended maintenance DMF dose was 23.1 % at 1–3 months, 26.9 % at 4–6 months, 42.3 % at 7–9 months, and 0 % at 10–12 months. There were no significant differences at any time window among the ODMT groups in the number of office visits or percent of patients receiving MRIs. Mobility indicator patterns (proportion of patients with abnormal gait, wheelchair use, etc.) were consistent over time. Conclusions There was no difference in persistency, prescribing patterns (medication switching, dose reduction, re-starts, and add-ons) or medical resource utilization (office-visits, MRI procedures, and mobility indicators) among the ODMTs. However, in a small sub-group of patients, delays of up to 9 months in DMF dose-up titration to the recommended maintenance dose were observed. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0698-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tara Nazareth
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | | | | | | | - John J Ko
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.
| | | | - Rahul Sasane
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
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Brunsveld-Reinders AH, Ludikhuize J, Dijkgraaf MGW, Arbous MS, de Jonge E. Unexpected versus all-cause mortality as the endpoint for investigating the effects of a Rapid Response System in hospitalized patients. Crit Care 2016; 20:168. [PMID: 27256068 PMCID: PMC4891908 DOI: 10.1186/s13054-016-1339-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Abstract
Background The purpose of this study was to assess the effect of replacing all-cause mortality by death without limitation of medical treatments (LOMT) as the endpoint in a study of rapid response teams (RRTs) in hospitalized patients. We also described the time course of LOMT orders in patients dying on a general ward and the influence of RRTs on such orders. Methods This study is a secondary analysis of the COMET trial, a pragmatic prospective Dutch multicenter before-after study. We repeated the original analysis of the influence of RRTs on death before hospital discharge by replacing all-cause mortality by death without an LOMT order. In a subgroup of all patients dying before hospital discharge, we documented patient demographics, admission characteristics and LOMT orders of each patient. Patients age 18 years or above were included. Results In total, 166,569 patients were included in the study. The unadjusted ORs were 0.865 (95 % CI 0.77-0.98) in the original analysis using all-cause mortality and 0.557 (95 % CI 0.40-0.78) when choosing death without LOMT as the endpoint. In total, 3408 patients died before discharge. At time of death, 2910 (85 %) had an LOMT order. Median time from last change in LOMT status and death was 2 days (IQR 1–5) in the before-phase and median time after introduction of the RRT was 1 day (IQR 1–4) (p value not significant). Conclusions The improvement in survival of hospitalized patients after introduction of a rapid response team in the COMET study was more pronounced when choosing death without limitation of medical treatment, rather than all deaths as the endpoint. Most patients who died during hospitalization had limitation of medical treatments ordered, often shortly before death. Rapid response teams did not influence the institution of limitation of medical treatments.
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Affiliation(s)
- Anja H Brunsveld-Reinders
- Department of Intensive Care, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, Netherlands.
| | - Jeroen Ludikhuize
- Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Research Unit, Academic Medical Center, Amsterdam, Netherlands
| | - M Sesmu Arbous
- Department of Intensive Care, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, Netherlands
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An Q, Chronister K, Song R, Pearson M, Pan Y, Yang B, Khuwaja S, Hernandez A, Hall HI. Comparison of self-reported HIV testing data with medical records data in Houston, TX 2012-2013. Ann Epidemiol 2016; 26:S1047-2797(16)30069-2. [PMID: 27151363 DOI: 10.1016/j.annepidem.2016.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/16/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the agreement between self-reported and medical record data on HIV status and dates of first positive and last negative HIV tests. METHODS Participants were recruited from patients attending Houston health clinics during 2012-2013. Self-reported data were collected using a questionnaire and compared with medical record data. Agreement of HIV status was assessed using kappa statistics and of HIV test dates using concordance correlation coefficient. The extent of difference between self-reported and medical record test dates was determined. RESULTS Agreement between self-reported and medical record data was good on HIV status and date of first positive HIV test, but poor on date of last negative HIV test. About half of participants that self-reported never tested had HIV test results in medical records. Agreement varied by sex, race and/or ethnicity, and medical care facility. For HIV-positive persons, more self-reported first positive HIV test dates preceded medical record dates, with a median difference of 6 months. For HIV-negative persons, more medical record dates of last negative HIV test preceded self-reported dates, with a median difference of 2 months. CONCLUSIONS Studies relying on self-reported HIV status other than HIV positive and self-reported date of last negative should consider including information from additional sources to validate the self-reported data.
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Affiliation(s)
- Qian An
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Karen Chronister
- Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW, Australia
| | - Ruiguang Song
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Megan Pearson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yi Pan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Biru Yang
- Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
| | - Salma Khuwaja
- Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
| | - Angela Hernandez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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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 DOI: 10.1016/j.ajic.2015.04.208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [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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Matt V, Matthew H. The retrospective chart review: important methodological considerations. J Educ Eval Health Prof 2013; 10:12. [PMID: 24324853 PMCID: PMC3853868 DOI: 10.3352/jeehp.2013.10.12] [Citation(s) in RCA: 283] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/23/2013] [Indexed: 05/14/2023]
Abstract
In this paper, we review and discuss ten common methodological mistakes found in retrospective chart reviews. The retrospective chart review is a widely applicable research methodology that can be used by healthcare disciplines as a means to direct subsequent prospective investigations. In many cases in this review, we have also provided suggestions or accessible resources that researchers can apply as a "best practices" guide when planning, conducting, or reviewing this investigative method.
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Bali A, Bali D, Iyer N, Iyer M. Management of medical records: facts and figures for surgeons. J Maxillofac Oral Surg 2011; 10:199-202. [PMID: 22942587 DOI: 10.1007/s12663-011-0219-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/27/2011] [Indexed: 11/24/2022] Open
Abstract
Medical records are the document that explains all detail about the patient's history, clinical findings, diagnostic test results, pre and postoperative care, patient's progress and medication. If written correctly, notes will support the doctor about the correctness of treatment. Inspite of knowing the importance of proper record keeping in India, it is still in the initial stages. Medical records are the one of the most important aspect on which practically almost every medico-legal battle is won or lost. This article discusses the various aspect of record maintenance.
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