Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

Objectives: The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. Setting: 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. Primary outcome measure: The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. Results: 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5-92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7-94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2-44.4%). Conclusions: Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004

Public Participation GIS for sustainable urban mobility planning: methods, applications and challenges

Sustainable mobility planning is a new approach to planning, and as such it requires new methods of public participation, data collection and data aggregation. In the article we present an overview of Public Participation GIS (PPGIS) methods with potential use in sustainable urban mobility planning. We present the methods using examples from two recent case studies conducted in Polish cities of Poznań and Łodź. Sustainable urban mobility planning is a cyclical process, and each stage has different data and participatory requirements. Consequently, we situate the PPGIS methods in appropriate stages of planning, based on potential benefits they may bring into the planning process. We discuss key issues related to participant recruitment and provide guidelines for planners interested in implementing methods presented in the paper. The article outlines future research directions stressing the need for systematic case study evaluation

Implementing a Community Bipolar Screening Questionnaire in VT

The National Institute of Mental Health estimates the number of adults with a diagnosed mental disorder is nearly 1 in 5, this equates to about 43 million Americans. The national shortage of psychiatrists has hit Vermont particularly hard. There has been both a lack of funding and a lack of psychiatrists. For example there is often a waiting line for acute level 1 beds at the Vermont Psychiatric Care Hospital since it opened after the flooding of the state hospital in 2011. In light of the shortage of resources and psychiatrists in Vermont it is important to maximize the limited time that family practitioners have with patients with mental illness. With regards to diagnosing bipolar spectrum disorder the best method is using the Mood Disorder Questionnaire (MDQ) which is a 17 question survey and practical for an outpatient setting. A study examining the validity of the MDQ found that it provided good sensitivity (0.73, 95% [CI]=0.65–0.81) without sacrificing specificity (0.90, 95% CI=0.84–0.96). Another study was conducted in a community setting and it was found that the MDQ had a sensitivity of 0.28 and a specificity of 0.97. The MDQ has been proven to be effective in a psychiatric outpatient setting and been proven to be less effective or limited in the outpatient setting. However we must weigh the risks and benefits. In a setting like Vermont, with restricted resources, limited inpatient beds, lack of psychiatrists and a population of individuals with undiagnosed bipolar spectrum disorder the MDQ can prove to be more useful than harmful and can aid in identifying patients who potentially have bipolar spectrum disorder.https://scholarworks.uvm.edu/fmclerk/1319/thumbnail.jp

Approaches to canine health surveillance

Effective canine health surveillance systems can be used to monitor disease in the general population, prioritise disorders for strategic control and focus clinical research, and to evaluate the success of these measures. The key attributes for optimal data collection systems that support canine disease surveillance are representativeness of the general population, validity of disorder data and sustainability. Limitations in these areas present as selection bias, misclassification bias and discontinuation of the system respectively. Canine health data sources are reviewed to identify their strengths and weaknesses for supporting effective canine health surveillance. Insurance data benefit from large and well-defined denominator populations but are limited by selection bias relating to the clinical events claimed and animals covered. Veterinary referral clinical data offer good reliability for diagnoses but are limited by referral bias for the disorders and animals included. Primary-care practice data have the advantage of excellent representation of the general dog population and recording at the point of care by veterinary professionals but may encounter misclassification problems and technical difficulties related to management and analysis of large datasets. Questionnaire surveys offer speed and low cost but may suffer from low response rates, poor data validation, recall bias and ill-defined denominator population information. Canine health scheme data benefit from well-characterised disorder and animal data but reflect selection bias during the voluntary submissions process. Formal UK passive surveillance systems are limited by chronic under-reporting and selection bias. It is concluded that active collection systems using secondary health data provide the optimal resource for canine health surveillance

Cognitive and mood assessment tools for use in stroke

No abstract available

Development and Psychometric Properties of A Screening Tool for Assessing Developmental Coordination Disorder in Adults

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder affecting motor coordination. Evidence suggests this disorder persists into adulthood and may be associated with biomechanical dysfunction and pain. We report on the development and initial validation of a questionnaire to assess for DCD in adults. Methods: An initial item pool (13 items) was derived from the American Psychiatric Association criteria and World Health Organisation definition for DCD. An expert panel assessed face and content validity which led to a 9-item Functional Difficulties Questionnaire (FDQ-9) with possible scores ranging from 9-36 (higher scores indicating greater functional difficulties). The FDQ-9 was piloted on individuals recruited from convenience samples. The underlying factor structure and aspects of reliability, validity and accuracy were tested. The Receiver Operating Characteristic Curve was employed to evaluate the diagnostic accuracy of the test using self-reported dyspraxia as the reference standard. Results: Principal Axis Factoring yielded a two factor solution relating to gross and fine motor skills; for conceptual parsimony these were combined. Internal reliability was high (0.81), the mean inter-item correlation was 0.51 and preliminary findings suggested satisfactory construct validity. The Area under the Curve was 0.918 [95% CI 0.84-1.00] indicating a diagnostic test with high accuracy. A cut-off score was established with a sensitivity and specificity of 86% [95% CI 78%-89%] and 81% [95 % CI 73%-89%] respectively. Test-retest reliability was good (ICC 0.96 [95% CI 0.92 to 0.98]. Conclusion: The psychometric properties of the FDQ-9 appear promising. Work is required to conduct further psychometric evaluations on new samples and apply the scale to clinical practice