Accuracy of Electronic Health Record Data for Identifying Stroke Cases in Large-Scale Epidemiological Studies: A Systematic Review from the UK Biobank Stroke Outcomes Group

Long-term follow-up of population-based prospective studies is often achieved through linkages to coded regional or national health care data. Our knowledge of the accuracy of such data is incomplete. To inform methods for identifying stroke cases in UK Biobank (a prospective study of 503,000 UK adults recruited in middle-age), we systematically evaluated the accuracy of these data for stroke and its main pathological types (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage), determining the optimum codes for case identification.We sought studies published from 1990-November 2013, which compared coded data from death certificates, hospital admissions or primary care with a reference standard for stroke or its pathological types. We extracted information on a range of study characteristics and assessed study quality with the Quality Assessment of Diagnostic Studies tool (QUADAS-2). To assess accuracy, we extracted data on positive predictive values (PPV) and-where available-on sensitivity, specificity, and negative predictive values (NPV).37 of 39 eligible studies assessed accuracy of International Classification of Diseases (ICD)-coded hospital or death certificate data. They varied widely in their settings, methods, reporting, quality, and in the choice and accuracy of codes. Although PPVs for stroke and its pathological types ranged from 6-97%, appropriately selected, stroke-specific codes (rather than broad cerebrovascular codes) consistently produced PPVs >70%, and in several studies >90%. The few studies with data on sensitivity, specificity and NPV showed higher sensitivity of hospital versus death certificate data for stroke, with specificity and NPV consistently >96%. Few studies assessed either primary care data or combinations of data sources.Particular stroke-specific codes can yield high PPVs (>90%) for stroke/stroke types. Inclusion of primary care data and combining data sources should improve accuracy in large epidemiological studies, but there is limited published information about these strategies

Psychosocial and behavioral characteristics of still smokers at 6 months after acute cerebro or cardiovascular events: Findings from INEV@L, a prospective pilot study

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The neurobiology of resilience

Neuroscience makes possible a new understanding of human nature. The practice of medicine is particularly stressful, and neuroscience helps explain why this is the case. When work is demanding and recovery poor, persistent stress begins to distort our view of ourselves, our patients, and our working world. Empathic doctors are safer, more effective and happier in their work, yet empathy fades as stress levels rise and this fuels the journey into ‘burnout’. If an unrelenting flight-or-fight mode makes us cognitively slower, less able to be empathic and communicative, family medicine turns into an overwhelming uphill struggle. Can this downward spiral be reversed? Resilience varies over time, depending on the balance of positive and negative influences; many of these needs being determined by our evolutionary heritage. A better grasp of current ideas about the interpersonal neurobiology of stress, emotion, social engagement and empathy can help us make sense of our predicament and find ways to embark on personal, organisational and cultural change. In challenging and stressful circumstances, if we can cultivate self-care and self-awareness, core values, and specially the ability to self-soothe, we may give ourselves a better chance to flourish both individually and as a profession

Burnout among physiotherapists and length of service

Objectives: The aim of this study was to identify factors that contribute to the development of burnout among physiotherapists with different length of service in physiotherapy. Material and Methods: The following research tools were used to study burnout: the Life Satisfaction Questionnaire (LSQ), based on FLZ (Fragebogen zur Lebenszufriedenheit) by Frahrenberg, Myrtek, Schumacher, and Brähler; the Burnout Scale Inventory (BSI) by Steuden and Okła; and an ad hoc questionnaire to collect socio-demographic data. The survey was anonymous and voluntary and involved a group of 200 active physiotherapists working in Poland. Results: A statistical analysis revealed significant differences in overall life satisfaction between length-of-service groups (p = 0.03). Physiotherapists with more than 15 years of service reported greater satisfaction than those with less than 5 years and between 5 and 15 years of service. The results suggest that burnout in those with 5-15 years of service is higher in physiotherapists working in health care centers and increases with age and greater financial satisfaction, while it decreases with greater satisfaction with friend and family relations and greater satisfaction with one's work and profession. In those with more than 15 years of service, burnout increases in the case of working in a setting other than a health care or educational center and decreases with greater satisfaction with one's work and profession. Conclusions: Job satisfaction and a satisfying family life prevent burnout among physiotherapists with 5-15 years of service in the profession. Financial satisfaction, age and being employed in health care may cause burnout among physiotherapists with 5-15 years of service. Physiotherapists with more than 15 years of service experience more burnout if they work in a setting other than a health care or educational center and less burnout if they are satisfied with their profession