Diagnostic data for neurological conditions in interRAI assessments in home care, nursing home and mental health care settings: a validity study

Background: The interRAI suite of assessment instruments can provide valuable information to support person-specific care planning across the continuum of care. Comprehensive clinical information is collected with these instruments, including disease diagnoses. In Canada, interRAI data holdings represent some of the largest repositories of clinical information in the country for persons with neurological conditions. This study examined the accuracy of the diagnostic information captured by interRAI instruments designed for use in the home care, long-term care and mental health care settings as compared with national administrative databases. Methods: The interRAI assessments were matched with an inpatient hospital record and emergency department (ED) visit record in the preceding 90 days. Diagnoses captured on the interRAI instruments were compared to those recorded in either administrative record for each individual. Diagnostic validity was examined through sensitivity, specificity and positive predictive value analysis for the following conditions: multiple sclerosis, epilepsy, Alzheimer's disease and other dementias, Parkinson's disease, traumatic brain injury, stroke, diabetes mellitus, heart failure and reactive airway disease. Results: In the three large study samples (home care: n = 128,448; long-term care: n = 26,644; mental health: n = 13,812), interRAI diagnoses demonstrated high specificity when compared to administrative records, for both neurological conditions (range 0.80 - 1.00) and comparative chronic diseases (range 0.83 - 1.00). Sensitivity and positive predictive values (PPV) were more varied by specific diagnosis, with sensitivities and PPV for neurological conditions ranging from 0.23 to 0.94 and 0.14 to 0.77, respectively. The interRAI assessments routinely captured more cases of the diagnoses of interest than the administrative records. Conclusions: The interRAI assessment collected accurate information about disease diagnoses when compared to administrative records within three months. Such information is likely relevant to day-to-day care in these three environments and can be used to inform care planning and resource allocation decisions.Public Health Agency of Canada. In addition, Dr. Hirdes’ participation is supported through the Ontario Home Care Research and Knowledge Exchange Chair funded by the Ontario Ministry of Health and Long Term Care. Dr. Marrie is supported, in part, by a Don Paty Career Development Award from the MS Society of Canad

Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England

Objective To assess the robustness of patient responses to a new national survey of patient experience as a basis for providing financial incentives to doctors

Rotation periods of late-type stars in the young open cluster IC 2602

We present the results of a monitoring campaign aimed at deriving rotation periods for a representative sample of stars in the young (30 Myr) open cluster IC 2602. Rotation periods were derived for 29 of 33 stars monitored. The periods derived range from 0.2d (one of the shortest known rotation periods of any single open cluster star) to about 10d (which is almost twice as long as the longest period previously known for a cluster of this age). We are able to confirm 8 previously known periods and derive 21 new ones, delineating the long period end of the distribution. Despite our sensitivity to longer periods, we do not detect any variables with periods longer than about 10d. The combination of these data with those for IC 2391, an almost identical cluster, leads to the following conclusions: 1) The fast rotators in a 30 Myr cluster are distributed across the entire 0.5 < B-V < 1.6 color range. 2) 6 stars in our sample are slow rotators, with periods longer than 6d. 3) The amplitude of variability depends on both the color and the period. The dependence on the latter might be important in understanding the selection effects in the currently available rotation period database and in planning future observations. 4) The interpretation of these data in terms of theoretical models of rotating stars suggests both that disk-interaction is the norm rather than the exception in young stars and that disk-locking times range from zero to a few Myr.Comment: 23 pages, 8 figures, accepted for publication in the Astrophysical Journa

3. Launching the New Enterprise

As the academic year of 1945-46 approached, the intensity of activity in preparation for actually opening the school in the fall term became overwhelming. Incredible though it may seem, Ives and Day were able in a period of a few weeks to assemble the nucleus of a faculty, several of whom formed a continuing source of counsel and advice both during the school’s formative years and thereafter. Includes: The First Dean and the School’s Dedication; A Participant’s View of the Early Years; Ives Moves On; Several Views of Martin P. Catherwood; The Founders

External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4.

Shortened versions of self-reported questionnaires may be used to reduce respondent burden. When shortened screening tools are used, it is desirable to maintain equivalent diagnostic accuracy to full-length forms. This manuscript presents a case study that illustrates how external data and individual participant data meta-analysis can be used to assess the equivalence in diagnostic accuracy between a shortened and full-length form. This case study compares the Patient Health Questionnaire-9 (PHQ-9) and a 4-item shortened version (PHQ-Dep-4) that was previously developed using optimal test assembly methods. Using a large database of 75 primary studies (34,698 participants, 3,392 major depression cases), we evaluated whether the PHQ-Dep-4 cutoff of ≥ 4 maintained equivalent diagnostic accuracy to a PHQ-9 cutoff of ≥ 10. Using this external validation dataset, a PHQ-Dep-4 cutoff of ≥ 4 maximized the sum of sensitivity and specificity, with a sensitivity of 0.88 (95% CI 0.81, 0.93), 0.68 (95% CI 0.56, 0.78), and 0.80 (95% CI 0.73, 0.85) for the semi-structured, fully structured, and MINI reference standard categories, respectively, and a specificity of 0.79 (95% CI 0.74, 0.83), 0.85 (95% CI 0.78, 0.90), and 0.83 (95% CI 0.80, 0.86) for the semi-structured, fully structured, and MINI reference standard categories, respectively. While equivalence with a PHQ-9 cutoff of ≥ 10 was not established, we found the sensitivity of the PHQ-Dep-4 to be non-inferior to that of the PHQ-9, and the specificity of the PHQ-Dep-4 to be marginally smaller than the PHQ-9