What does validation of cases in electronic record databases mean? The potential contribution of free text

Electronic health records are increasingly used for research. The definition of cases or endpoints often relies on the use of coded diagnostic data, using a pre-selected group of codes. Validation of these cases, as ‘true’ cases of the disease, is crucial. There are, however, ambiguities in what is meant by validation in the context of electronic records. Validation usually implies comparison of a definition against a gold standard of diagnosis and the ability to identify false negatives (‘true’ cases which were not detected) as well as false positives (detected cases which did not have the condition). We argue that two separate concepts of validation are often conflated in existing studies. Firstly, whether the GP thought the patient was suffering from a particular condition (which we term confirmation or internal validation) and secondly, whether the patient really had the condition (external validation). Few studies have the ability to detect false negatives who have not received a diagnostic code. Natural language processing is likely to open up the use of free text within the electronic record which will facilitate both the validation of the coded diagnosis and searching for false negatives

Secondary use of data recorded in primary care: insights from human computer interaction field studies

Introduction: Electronic health records from primary care, are now aggregated in a number of large datasets from primary care settings, containing both coded data and free-text. Secondary users can easily undertake analyses using coded data. However although the balance of information between these codes and free text is variable, they rarely use the information contained in doctors’ free-text notes - because of their ‘messy’ nature and the costs of ensuring anonymity. Our epidemiological studies within the Patient Records Enhancement Project has demonstrated that free text contains important information, that is often ignored. Method: Human computer interaction (HCI) studies, using qualitative approaches, can help us understand the reasons for variability in the balance of coded and free text data. We undertook field studies in six GP surgeries which included observations of record use across the surgery, video analysis of real patient consultations and interviews with a range of surgery staff. We also undertook ‘simulated’ consultations, with two medical actors playing the part of the patient, allowing us to standarise the patient across doctors and software systems. Results: Preliminary results suggest several reasons for variation in data recording. Doctors create notes in order to best manage patients with little consideration for use by others, and reported limited awareness of secondary uses of the information. Doctors often record and “read” a picture painted by the overall record of a consultation or record symptoms and signs in free text notes, and choose not to code a definite diagnosis. If coding, they often choose a more general non specific code, even when they have inferred and acted on a clear diagnosis. These approaches reflect processes of progressing from differential to definite diagnosis, and the surgery’s administrative and consultation processes. Conclusion: Our findings may explain apparent delays in diagnosis often observed in epidemiological analyses. The picture portrayed within records may not be at all clear to researchers relying on coded data. Our results have implications for secondary users of data and assessment of data for quality of care. Follow on work might result in typologies of diseases liable to coded data deficits and support software development

The early presentation and management of rheumatoid arthritis cases in primary care

Recent NICE guidance has emphasised the importance of early recognition and referral of patients with inflammatory arthritis so that disease modifying treatment can be promptly initiated. The timely identification of such patients, given the large numbers consulting with musculoskeletal complaints, is a considerable challenge and descriptive data from primary care are sparse. Our objective was to examine GP records from three years before to 14 days after the first coded diagnosis of rheumatoid arthritis in order to describe the early course and management of the diseas

It's good for students when parents work with teachers to design and produce their education.

The New York City Department of Education has long recognized the role of parent involvement in student academic achievement. Indeed, parents and teachers can work together to 'coproduce' educational services to benefit student achievement. However, we do not know what kind of coproduction directly and effectively supports educational attainment. In a new research, Julio Zambrano-Gutiérrez, Amanda Rutherford, and Sean Nicholson-Crotty ..

Motivations and Goals of Parents Participating in the Working With Parents Manual Pilot Study

Understanding the motivations and goals of parents participating in parenting programs is crucial for developing effective parenting programs and keeping participants engaged. This study reviews the motivations and goals of participants in the Working With Parents Manual (WWPM) Pilot Study (Mowder, 2022). The WWPM is based on the Parent Development Theory (PDT) which defines six categories of important parenting behaviors (i.e., Bonding, Discipline, Education, General Welfare and Protection, Responsivity, Sensitivity). The study explores parents\u27 motivations and goals for participating in the WWPM program, the impact participation has on parenting behaviors, and the relationship between parenting goals and program satisfaction. A total of 26 participants were included in quantitative and qualitative data analyses. Results indicate that responsivity was the most common parenting goal of participants in the program, while bonding and sensitivity were the most common primary motivating factors for participants’ enrollment. Additionally, common qualitative themes of improving the parent-child relationship and improving parenting skills were determined. This study finds that participants completing the WWPM gave evidence of significant changes in importance of both positive and negative parenting behaviors. Participant feedback indicates a consistent overall positive view of participation in the WWPM from parents, regardless of specific parenting goal(s). These findings may inform the development and implementation of effective and relevant programs that support positive parenting practices and potentially enhance outcomes for parents, children, and families

Anne Boleyn: Living a Thousand Lives Forever

Writers and historians from earlier centuries imagined Anne Boleyn as a villain; a forward and evil woman intent on destroying Henry VII and his image. Modern accounts have been more accommodating, offering that she was misunderstood due to the constraints of the times. In an attempt to discover the historical Anne, I will be comparing and contrasting how she has been perceived in fiction and non-fiction literature, and will examine how the perception of Anne has shifted through time

Kind King or Tyrannical Ruler? An Analysis of Hilary Mantel’s Henry VIII in Wolf Hall and Bringing up the Bodies

Henry VIII (28 June 1491 – 28 January 1547) served as King of England from 1509 until his death in 1547. A melancholic character, Henry was known for his many marriages, his temper, his bouts of tyranny, and his break with the Catholic Church. Most authors, even those writing contemporary accounts, portray Henry as a villain. Hilary Mantel paints Henry differently. In Wolf Hall and Bringing up the Bodies, the King is as he has always been; argumentative, sardonic, and excessive. However, Mantel chooses to augment these parts of his character with some of his better traits, giving the King a softer edge that is often lost to his actions and infamy. An analysis of Mantel’s writing, as compared to the historical record, sheds new light on Henry VIII and invites readers, through the joy of historical fiction, to be more open in their interpretation of the King

Applying the Golden Rule towards Recruitment Effectiveness

The purpose of the present work was threefold: (1) to examine the perceptions of what makes retail recruiting organizations attractive to college undergraduates and examine what attributes recruiting organizations believe students are attracted to; (2) to examine the differences in these perceptions with particular interest in the role of the recruiters themselves and (3) to test whether specific recruitment attributes, ranked highly by the students, impacted variables already cited in the extant literature, in order to assist human resources professionals increase the effectiveness of their recruitment practices. In the fall of 2008, four in-depth interviews with key retail recruiters, and a focus group with six senior retail undergraduate students were held. The following spring a Q-study was administered to eight recruiters and nineteen students utilizing the data collected from the focus group and interviews. In fall of 2010 and early 2011, three conjoint analysis experiments were conducted to measure the impact of specific recruiter behaviors identified by the students as being of key importance to their attraction, upon the variables of personableness, informativeness and competence, widely cited as being of significance to applicant attraction in the recruitment literature. An additional experiment was conducted to measure the impact of these behaviors on likelihood to pursue an opportunity with this organization. The specific recruitment behaviors were summarized as structured interview format, relationship with student, and sustained presence on campus. Findings indicated that college undergraduates and recruitment professionals differ significantly in what they believe is of importance in attracting student applicants to organizations and the conjoint analysis experiments showed a strong influence by the identified recruitment behaviors on two of the variables from the extant literature

Optimising use of electronic health records to describe the presentation of rheumatoid arthritis in primary care: a strategy for developing code lists

Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice