Establishment of methods for extracting and analysing patient data from electronic practice management software systems used in first opinion veterinary practice in the UK

Examining patient records is a useful way to identify common conditions and treatment outcomes in veterinary practice and data gathered can be fed back to the profession to assist with clinical decision making. This research aimed to develop a method to extract clinical data from veterinary electronic patient records (EPRs) and to assess the value of the data extracted for use in practice-based research. The transfer of new research from continuing professional development (CPD) into practice was also considered. An extensible mark-up language (XML) schema was designed to extract information from a veterinary EPR. The analysis of free text was performed using a content analysis program and a clinical terms dictionary was created to mine the extracted data. Data collected by direct observation was compared to the extracted data. A review of research published in the proceedings of a popular veterinary CPD event, British Small Animal Veterinary Association (BSAVA) Congress, was appraised for evidence quality. All animal records were extracted and validation confirmed 100% accuracy. The content analysis produced results with a high specificity (100%) and the mined data analysis was successful in assessing the prevalence of a specific disease. On comparison, the data extracted from the EPR contained only 65% of all data recorded by direct observation. The review of BSAVA Congress abstracts found the majority of the clinical research abstracts (CRAs) presented to be case reports and case series, with differences in focus between CRAs and veterinary lecture stream abstracts. This study has demonstrated that data extraction using an XML schema is a viable method for the capture of patient data from veterinary EPRs. The next step will be to understand the differences found between data collected by observation and extraction, and to investigate how research presented as CPD is received, appraised and applied by the veterinary profession

Establishment of methods for extracting and analysing patient data from electronic practice management software systems used in first opinion veterinary practice in the UK

Examining patient records is a useful way to identify common conditions and treatment outcomes in veterinary practice and data gathered can be fed back to the profession to assist with clinical decision making. This research aimed to develop a method to extract clinical data from veterinary electronic patient records (EPRs) and to assess the value of the data extracted for use in practice-based research. The transfer of new research from continuing professional development (CPD) into practice was also considered. An extensible mark-up language (XML) schema was designed to extract information from a veterinary EPR. The analysis of free text was performed using a content analysis program and a clinical terms dictionary was created to mine the extracted data. Data collected by direct observation was compared to the extracted data. A review of research published in the proceedings of a popular veterinary CPD event, British Small Animal Veterinary Association (BSAVA) Congress, was appraised for evidence quality. All animal records were extracted and validation confirmed 100% accuracy. The content analysis produced results with a high specificity (100%) and the mined data analysis was successful in assessing the prevalence of a specific disease. On comparison, the data extracted from the EPR contained only 65% of all data recorded by direct observation. The review of BSAVA Congress abstracts found the majority of the clinical research abstracts (CRAs) presented to be case reports and case series, with differences in focus between CRAs and veterinary lecture stream abstracts. This study has demonstrated that data extraction using an XML schema is a viable method for the capture of patient data from veterinary EPRs. The next step will be to understand the differences found between data collected by observation and extraction, and to investigate how research presented as CPD is received, appraised and applied by the veterinary profession

A method for extracting electronic patient record data from practice management software systems used in veterinary practice

BackgroundData extracted from electronic patient records (EPRs) within practice management software systems are increasingly used in veterinary research. The use of real patient data gives the potential to generate research that can readily be applied to clinical practice. The use of veterinary EPRs for research in the United Kingdom is hindered by the number of different Practice Management System (PMS) providers used by practices, as obtaining and combining data from different systems electronically can be problematic. The use of extensible mark up language (XML) to extract clinical data for research would potentially resolve the compatibility issues between systems. The aim of this study was to establish and validate a method for the extraction of small animal patient records from a veterinary PMS that could potentially be used across multiple systems. An XML schema was designed to extract clinical information from EPRs. The schema was tested and validated in a test system, and was then tested in a real small animal practice where data was extracted for 16 weeks. A 10 % sample of the extracted records was then compared to paper copies provided by the practice.ResultsAll 21 fields encoded by the XML schema, from all of the records in the test system, were extracted with 100 % accuracy. Over the 18 week data collection period 4946 records, from 1279 patients, were extracted from the small animal practice. The 10 % printed records checked and compared with the XML extracted records demonstrated all required data was present. No unrequired, sensitive information e.g. costs or services/products or personal client information was extracted.ConclusionsThis is the first time a method for data extraction from EPRs in veterinary practice using an XML schema has been reported in the United Kingdom. This is an efficient and accurate way of extracting data which could be applied to all PMSs nationally and internationally

Interventions for Complex Traumatic Events (INCiTE): Systematic review and research prioritisation exercise

Background: People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people. Objective: To identify candidate psychological and non-pharmacological treatments for future research. Design: Mixed-methods systematic review. Participants: Adults aged 65 18 years with a history of complex traumatic events. Interventions: Psychological interventions versus control or active control; pharmacological interventions versus placebo. Main outcome measures: Post-traumatic stress disorder symptoms, common mental health problems and attrition. Data sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017. Review methods: Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist. Results: One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs. Limitations: Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented. Conclusions: Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder. Future work: Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities. Study registration: This study is registered as PROSPERO CRD42017055523. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information