The diagnosis of cerebral palsy in two Danish national registries: a validation study

AIMS

To determine the quality of prospectively collected data from the highly specialized Danish Cerebral Palsy Follow-up Program (CPOP), and to establish the validity of a reported cerebral palsy (CP) diagnosis in the Danish National Patient Registry (NPR), regularly used as a proxy for neurodevelopmental disorders in epidemiological research.

METHODS

We compared data from the two registries on children with registered CP, born in Denmark between 2008 and 2009, with information from medical records verified by two experienced physicians specializing in pediatric neurology. Data accuracy was estimated by completeness, correctness, and reliability. Completeness was calculated as the number of cases with correctly registered CP diagnoses divided by the total number of true CP diagnoses (similar to sensitivity). Correctness was calculated as the number of cases with correct registrations divided by the total number of cases (similar to positive predictive value). Reliability was estimated using kappa statistics.

RESULTS

Registered CP diagnoses in the CPOP had high accuracy, with 94% correctness and 91% completeness. Furthermore, most key variables in the CPOP showed excellent reliability, especially variables defining the severity of the condition. In the Danish NPR, only 225 of 348 children with a noted CP diagnosis fulfilled the diagnostic criteria for CP, resulting in 65% correctness.

CONCLUSIONS

Danish CPOP data are a valid source for epidemiological research. Conversely, a noted CP diagnosis in the Danish NPR was, at best, correct in only two out of three patients.

Validity of self-reported educational level in the Tromsø Study

BACKGROUND

Self-reported data on educational level have been collected for decades in the Tromsø Study, but their validity has yet to be established.

AIM

To investigate the completeness and correctness of self-reported educational level in the Tromsø Study, using data from Statistics Norway. In addition, we explored the consequence of using these two data sources on educational trends in cardiometabolic diseases.

METHODS

We compared self-reported and Statistics Norway-recorded educational level (primary, upper secondary, college/university <4 years, and college/university ⩾4 years) among 20,615 participants in the seventh survey of the Tromsø Study (Tromsø7, 2015-2016). Sensitivity, positive predictive value and weighted kappa were used to measure the validity of self-reported educational level in three age groups (40-52, 53-62, 63-99 years). Multivariable logistic regression was used to compare educational trends in cardiometabolic diseases between self-reported and Statistics Norway-recorded educational level.

RESULTS

Sensitivity of self-reported educational level was highest among those with a college/university education of 4 years or more (⩾97% in all age groups and both sexes). Sensitivity for primary educational level ranged from 67% to 92% (all age groups and both sexes). The lowest positive predictive value was observed among women with a college/university education of 4 years or more (29-46%). Weighted kappa was substantial (0.52-0.59) among men and moderate to substantial (0.41-0.51) among women. Educational trends in the risk of cardiometabolic diseases were less pronounced when self-reported educational level was used.

CONCLUSIONS

Self-reported educational level in Tromsø7 is adequately complete and correct. Self-reported data may produce weaker associations between educational level and cardiometabolic diseases than registry-based data.

Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study

BACKGROUND

Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy.

METHODS

The present study is a multicenter, cross-sectional study.

RESULTS

275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2-10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%).

CONCLUSIONS

Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.

A proposed metric set for evaluation of genome assembly quality

Quality control is essential for genome assemblies; however, a consensus has yet to be reached on what metrics should be adopted for the evaluation of assembly quality. N50 is widely used for contiguity measurement, but its effectiveness is constantly in question. Prevailing metrics for the completeness evaluation focus on gene space, yet challenging areas such as tandem repeats are commonly overlooked. Achieving correctness has become an indispensable dimension for quality control, while prevailing assembly releases lack scores reflecting this aspect. We propose a metric set with a set of statistic indexes for effective, comprehensive evaluation of assemblies and provide a score of a finished assembly for each metric, which can be utilized as a benchmark for achieving high-quality genome assemblies.

Counterfactual Anonymous Quantum Teleportation in the Presence of Adversarial Attacks and Channel Noise

Hiding the identity of involved participants in the network, known as anonymity, is a crucial issue in some cryptographic applications such as electronic voting systems, auctions, digital signatures, and Byzantine agreements. This paper proposes a new anonymous quantum teleportation protocol based on counterfactual communication where no information-carrying particles pass through the channel. It is achieved by the distribution of a counterfactual entanglement among the participants in the network followed by the establishment of an anonymous entanglement between the sender and the receiver. Afterwards, the sender can anonymously teleport a quantum state to the receiver by utilizing the anonymous entanglement. However, the practicality of the anonymous quantum network mainly calls for two performance measures-robustness against adversarial attacks and noisy environments. Motivated by these demands, firstly, we prove the security of our proposed protocol and show that it achieves both the sender and receiver's anonymity in the presence of active adversaries and untrusted parties. Along with anonymity, we also ensure the correctness of the protocol and the privacy of the teleported qubit. Finally, we analyze the robustness of our proposed protocol under the presence of channel noise and compare its fidelity with those of the conventional protocols. The main advantage of our proposed protocol is that it can provide useful anonymous quantum resources for teleportation under noisy environment with a higher security compared to previous protocols.

The correctness and completeness of documentation of parameters on the partographs used by midwives in primary healthcare facilities in midwestern Uganda: A retrospective descriptive study

AIM

This study was conducted to determine the correctness and completeness of documentation of partographs.

DESIGN

This was a retrospective descriptive study.

METHODS

We included 365 partographs of deliveries conducted from January 1st to October 31st 2019. Data were collected using a checklist and analysed descriptively. The study based on 13 partograph parameters.

RESULTS

About 8-13 parameters were correctly documented in 71.5 % of the partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine contractions and cervical dilatation respectively. About 12.1% of the cervicographs crossed the action line and 61.4% of partographs where cervicographs crossed the action line had no documentation of action(s) taken.

How to Validate Data Quality in a Trauma Registry? The Helsinki Trauma Registry Internal Audit

BACKGROUND AND AIMS

Trauma registry data are used for analyzing and improving patient care, comparison of different units, and for research and administrative purposes. Data should therefore be reliable. The aim of this study was to audit the quality of the Helsinki Trauma Registry internally. We describe how to conduct a validation of a regional or national trauma registry and how to report the results in a readily comprehensible form.

MATERIALS AND METHODS

Trauma registry database of Helsinki Trauma Registry from year 2013 was re-evaluated. We assessed data quality in three different parts of the data input process: the process of including patients in the trauma registry (case completeness); the process of calculating Abbreviated Injury Scale (AIS) codes; and entering the patient variables in the trauma registry (data completeness, accuracy, and correctness). We calculated the case completeness results using raw agreement percentage and Cohen's κ value. Percentage and descriptive methods were used for the remaining calculations.

RESULTS

In total, 862 patients were evaluated; 853 were rated the same in the audit process resulting in a raw agreement percentage of 99%. Nine cases were missing from the registry, yielding a case completeness of 97.1% for the Helsinki Trauma Registry. For AIS code data, we analyzed 107 patients with severe thorax injury with 941 AIS codes. Completeness of codes was 99.0% (932/941), accuracy was 90.0% (841/932), and correctness was 97.5% (909/932). The data completeness of patient variables was 93.4% (3899/4174). Data completeness was 100% for 16 of 32 categories. Data accuracy was 94.6% (3690/3899) and data correctness was 97.2% (3789/3899).

CONCLUSION

The case completeness, data completeness, data accuracy, and data correctness of the Helsinki Trauma Registry are excellent. We recommend that these should be the variables included in a trauma registry validation process, and that the quality of trauma registry data should be systematically and regularly reviewed and reported.

A Comprehensive Technological Survey on the Dependable Self-Management CPS: From Self-Adaptive Architecture to Self-Management Strategies

Cyber Physical Systems (CPS) has been a popular research area in the last decade. The dependability of CPS is still a critical issue, and few surveys have been published in this domain. CPS is a dynamic complex system, which involves various multidisciplinary technologies. To avoid human errors and to simplify management, self-management CPS (SCPS) is a wise choice. To achieve dependable self-management, systematic solutions are necessary to verify the design and to guarantee the safety of self-adaptation decisions, as well as to maintain the health of SCPS. This survey first recalls the concepts of dependability, and proposes a generic environment-in-loop processing flow of self-management CPS, and then analyzes the error sources and challenges of self-management through the formal feedback flow. Focusing on reducing the complexity, we first survey the self-adaptive architecture approaches and applied dependability means, then we introduce a hybrid multi-role self-adaptive architecture, and discuss the supporting technologies for dependable self-management at the architecture level. Focus on dependable environment-centered adaptation, we investigate the verification and validation (V&V) methods for making safe self-adaptation decision and the solutions for processing decision dependably. For system-centered adaptation, the comprehensive self-healing methods are summarized. Finally, we analyze the missing pieces of the technology puzzle and the future directions. In this survey, the technical trends for dependable CPS design and maintenance are discussed, an all-in-one solution is proposed to integrate these technologies and build a dependable organic SCPS. To the best of our knowledge, this is the first comprehensive survey on dependable SCPS building and evaluation.

Quality assessment of Major Trauma Registry of Navarra: completeness and correctness

This study assessed the completeness of the Major Trauma Registry of Navarra (MTR-N) data and their concordance with the patients' medical files. It retrospectively reviewed all the MTR-N cases documented in June and July of 2014 and 2015. For each case, 42 parameters' values were taken from the MTR-N. To assess concordance between the MTR-N and medical files, the same variables values were re-recorded. Data completeness was calculated for all cases and data correctness for those documented in the MTR-N, separately for each variable. The overall average completeness rate for all variables was 92.8%. The percentages of completely missing data ranged from 0% (29 variables) to 76.8% (base excess). The overall average rate of correctness was 98.0%. Exact concordance ranged from 93.0% (7 variables) to 100% (22 variables). This study demonstrates the reliability and validity of the MTR-N data and its effectiveness for quality improvement and research in our community.

Opportunities and Pitfalls in the Definition of Data Validity

Several dimensions of data quality are described in the literature. One overriding aspect is considered to be the extent to which data represent the truth which is captured by data validity. Unfortunately, a common terminology, well defined concepts, and approved measures are missing in regard to data validity. In particular, there is a need to discuss the gold standard as reference for the data at hand and respective measures. Ultimate gold standard would be the state of the patient which itself is subjected to human and personal interpretations. Usually, an often diverse form of source data is used as gold standard. Based on the concept of the measure, it might be inappropriate differentiating between present and absent while calculating precision and recall. Due to the complexity and uncertainty of many health care related issues, a more sophisticated comparison might be necessary in order to establish relevant and general figures of data quality. Unfortunately, a harmonization in this field is not visible. Further research is needed to establish validated standards to measure data quality.

Preserving medical correctness, readability and consistency in de-identified health records

A health record database contains structured data fields that identify the patient, such as patient ID, patient name, e-mail and phone number. These data are fairly easy to de-identify, that is, replace with other identifiers. However, these data also occur in fields with doctors' free-text notes written in an abbreviated style that cannot be analyzed grammatically. If we replace a word that looks like a name, but isn't, we degrade readability and medical correctness. If we fail to replace it when we should, we degrade confidentiality. We de-identified an existing Danish electronic health record database, ending up with 323,122 patient health records. We had to invent many methods for de-identifying potential identifiers in the free-text notes. The de-identified health records should be used with caution for statistical purposes because we removed health records that were so special that they couldn't be de-identified. Furthermore, we distorted geography by replacing zip codes with random zip codes.

Comparison of the validity of stroke diagnoses in a medical quality register and an administrative health register

AIMS

Health registers are essential sources of data used in a wide range of stroke research, including epidemiological, clinical and healthcare studies. Regardless of the type of register, the data must be of high quality to be useful. In this study, we investigated and compared the correctness and completeness of the Norwegian Patient Register (an administrative health register) and the Norwegian Stroke Register (a medical quality register for acute stroke).

METHODS

We reviewed the medical records for 5192 admissions to hospital in 2012 and defined cases of stroke in the two registers as true positive, false positive, true negative or false negative. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value with 95% confidence intervals assuming a normal approximation of the binomial distribution.

RESULTS

The Norwegian Stroke Register was highly correct and relatively complete (sensitivity 88.1%, specificity 100% and PPV 98.6%). The Norwegian Patient Register was more complete, but less correct, when we included both the main and secondary diagnoses of stroke (sensitivity 96.8%, specificity 99.6% and PPV 79.7%); restricting the analyses to the main diagnoses of stroke resulted in less complete and more correct registrations (sensitivity 86.1%, specificity 99.9% and PPV 93.5%).

CONCLUSIONS

The Norwegian Stroke Register and the Norwegian Patient Register are adequately complete and correct to serve as valuable sources of data for epidemiological, clinical and healthcare studies, as well as for administrative purposes.

Attitude Certainty and Conflict Style: Divergent Effects of Correctness and Clarity

Little research has examined the properties of people's attitudes that predict how they will respond to conflict with others whose opinions differ. We propose that one aspect of attitude certainty-attitude correctness, or the perception that one's attitude is the "right" attitude to have-will predict more competitive conflict styles. This hypothesis was tested across five data sets comprising four studies. In Studies 1a and 1b, perceptions of attitude correctness (but not another form of attitude certainty, attitude clarity) predicted participants' tendencies to send competitive messages to an ostensible partner who held the opposite opinion. In Studies 2 to 4, manipulations of attitude correctness, but not attitude clarity (Study 3), also increased competitiveness in conflict, and perceived correctness mediated the effect of the correctness manipulation on conflict style (Study 4). The present research has implications for both the predictors of conflict style and the consequences of different forms of attitude certainty.