Chart Methodology Research Articles

Data quality indicators for daily life chart methodology: prospective self-ratings of bipolar disorder and alcohol use.

BackgroundSelf-rating instruments which require a large number of repeated assessments over time are increasingly popular in psychiatry. They are well suited to describing variations in mental states, especially in order to investigate effects of behaviour and events on functioning and mood. For bipolar disorder, the self-rating instrument ‘NIMH daily life chart’ was developed to assess the course of the illness. This instrument has been validated in the customary ways, yet information about data quality (e.g. completeness, consistency, construct validity, reactivity) was lacking. The goal of this study was to develop several data quality indicators computed from data, in order to be able to detect respondents that provide less valid or reliable data.MethodsDuring approximately 1 year on average, 137 patients with DSM-IV diagnosed bipolar disorder rated their mood, functioning and number of alcohol units consumed on a daily basis. Three kinds of quality indicators were developed: (1) compliance (i.e. completeness of recording on a daily basis), (2) the association between conceptually related variables—construct validity—and (3) reactivity: any changes in alcohol-drinking behaviour due to the assessments themselves. Relations were measured with Spearman’s rho.ResultsA relation was found between data quality and illness severity: respondents with lower data quality, according to our operationalisations, were more strongly affected by the illness, as expressed in the number of ill days, than respondents with higher data quality.ConclusionThe more affected patients are by the illness, the lower the data quality to be expected in life chart reports.

Bobby Fischer in Socio-Cultural Perspective: Application of Hiller’s (2011) Multi-Layered Chronological Chart Methodology

This article presents a case study application of Hiller’s (2011) Multi - Layered Chronological Chart (MLCC) methodology to the life story of former World Chess Champion Bobby Fischer. Designed for use in qualitative biographical studies, the MLCC is adapted here for psychobiographical research. In 1972, Fischer became an American Cold War hero as he wrestled the World Chess Championship from a half century of Soviet domination. His rapid rise to world fame was followed by infamy as Fischer abandoned competitive chess, grew increasingly Anti - Semitic and Anti - American, became a fugitive from U.S. justice, and died in relative isolation in Reykjavik, Iceland. Fischer remains one of the more enigmatic personalities of the 20th century and many questions remain regarding his psychological health. The MLCC method is used to contextualize Fischer’s life in nine key topical domains across five developmental life stages. The value of the MLCC methodology to psychobiographical research is highlighted and suggestions for advancing this methodology are put forth.

The Reduction of Modal Sensor Channels through a Pareto Chart Methodology

Presented herein is a new experimental sensor placement procedure developed to assist in placing sensors in key locations in an efficient method to reduce the number of channels for a full modal analysis. It is a fast, noncontact method that uses a laser vibrometer to gather a candidate set of sensor locations. These locations are then evaluated using a Pareto chart to obtain a reduced set of sensor locations that still captures the motion of the structure. The Pareto chart is employed to identify the points on a structure that have the largest reaction to an input excitation and thus reduce the number of channels while capturing the most significant data. This method enhances the correct and efficient placement of sensors which is crucial in modal testing. Previously this required the development and/or use of a complicated model or set of equations. This new technique is applied in a case study on a small unmanned aerial system. The test procedure is presented and the results are discussed.

Long term course of bipolar I disorder in India: Using retrospective life chart method

BackgroundThere are grounds to believe that the course of bipolar disorder may be different in tropical countries such as India when compared to temperate nations. There is a dearth of literature about the course of bipolar I disorder from India. MethodsThis study was conducted in a multispecialty teaching hospital in southern India. Patients with a DSM-IV TR diagnosis of bipolar I disorder, confirmed using SCID-I, with a minimum duration of illness of 3 years were assessed. Information was gathered on demographic and clinical variables, and the life course of episodes was charted using the National Institute of Mental Health – Life Chart Methodology Clinician Retrospective Chart (NIMH-LCM-CRC). ResultsA total of 150 patients with bipolar disorder were included. The mean age at onset of illness was 24.8 (±8.2) years. Mania was the first episode in a majority (85%) of the cases, and was the most frequent episode in the course of the illness, followed by depression. Patients spent an average of 11.1% of the illness duration in a mood episode, most commonly a manic episode. The median duration of manic or depressive episode was 2 months. Median time to recurrence after the first episode was 21 months (inter-quartile range of 10–60 months), and was shorter for women than men. LimitationsThe hospital based sample from a particular region limits generalizability. Recall bias may be present in this retrospective information based study. Medical illness, personality disorders, other Axis I psychiatric disorders (apart from substance use disorder) and influence of adherence to treatment on the course of the disorder were not assessed systematically. ConclusionsBipolar I disorder among Indian patients has a course characterized by predominantly manic episodes, which is in line with previous reports from tropical countries and substantially different from that of temperate regions.

Life Chart Methodology: risks associated with failing to assess patient preferences and the sources of poor insight for patients with bipolar disorder.

van Bendegem, van den Heuvel, Kramer, and Goossens (2014) present important information about how patients with bipolar disorder experience the use of a treatment methodology referred to as Life Chart Methodology. This procedure has patients with bipolar disorder formally review and reflect on pertinent life experience with the goal of assisting them to become more aware of patterns of emotional experience and behavior that are signs of a potential relapse. The authors cite Daggenvoorde, Goossens, and Gamel (2013), noting that “early detection of prodromal symptoms can help patients gain control over their illness allowing them to undertake early inter-ventions to prevent exacerbations and thus promote self-management of illness” (p. 378). Based on unstructured in-depth interviews of 14 patients who used this treat-ment, the authors noted some positive outcomes linked with this methodology but caution that there was consid-erable variability in how this methodology was perceived and, in particular, that there were many in an early phase of illness who felt uncomfortable with these procedures.Lack of awareness of illness is a considerable problem for persons with serious and prolonged psychiatric condi-tions (Lincoln, Lullman, & Reif, 2007). Estimates sug-gest that a large number of persons either deny or cannot perceive symptoms, consequences, and treatment needs linked with mental illness despite the urging of well-meaning members of their family, community, and men-tal health professionals (Amador et al., 1994). Manifestly, this is deeply problematic given that without a coherent understanding of one’s medical condition, the chance of adherence to potentially helpful treatments is unlikely.Life Chart Methodology is, accordingly, a response to calls from many quarters for procedures that help persons with serious mental illness to become more aware of their challenges. Following and expanding on the reflections of van Bendegem et al. (2014) about the experiences of patients using the Life Chart Methodology, this commen-tary suggests that dangers to patient health should be acknowledged and considered prior to its use. In particu-lar, we propose that no matter how benevolent the inten-tions of the clinician are, if this intervention is not in close sync with patients’ agendas, and if there is no consideration of the different factors responsible for patients’ lack of insight, this approach may work against recovery.To begin, contemporary models of wellness in severe mental illness emphasize that patients must take charge of their own recovery in the sense that they must make their own meaning of their difficulties and decide, there-fore, how they want to respond. Thus, our first concern about the Life Chart Methodology is that unless patients seek the same ends as those intended by the Life Chart Methodology, the procedure risks placing these patients again in a passive role. The key issue we see is that not all patients may want the kinds of knowledge that this meth-odology may seek to provide. Many patients may not exactly know what they are “getting into” when they begin such an exercise. If they are not interested in becoming aware of their mental illness in the manner of the Life Chart Methodology, the insights this process generates may be experienced as something imposed on the patient and may, thus, despite well-intentions of clini-cians, become a paternalistic approach. It may be per-ceived as knowledge forced on them rather than as some kind of new awareness that is the product of mutual discovery.Worse though is that many others may experience the knowledge that they have a mental illness as oppressive. For instance, patients who hold stigmatizing beliefs about mental illness may find themselves forced to self-stigma-tize if guided and urged to accept that they are ill. Evidence that this could occur includes studies reporting that heightened insight is sometimes correlated with poorer quality of life for some with serious mental illness

Attitudes of Patients With Bipolar Disorder Toward the Life Chart Methodology

The Dutch guideline for bipolar disorder (BD) recommends the use of the Life Chart Methodology (LCM) to help patients to monitor fluctuating mood patterns. But in practice patients show ambivalent attitudes toward this instrument. To describe attitudes and motivations of patients with BD for (non-)using the LCM. A phenomenological study with unstructured in-depth interviews of 14 patients with BD. Patient narratives were audio-taped, transcribed verbatim, analyzed, and coded inductively. The results show that despite variability in perceptions and willingness to work with the LCM, the general attitude toward this instrument was a recognized value for using the LCM. However, the emotional impact of daily mood charting was experienced as a substantial burden, particularly during the early stages of diagnosis. The impact of the diagnosis of BD needs to be taken in account when introducing the instrument for the first time to a patient.

The Effect of Sleep Disturbance during Pregnancy and Perinatal Period on Postpartum Psychopathology in Women with Bipolar Disorder

Background: Postpartum psychosis is a severe condition that usually requires hospital admission as result of the highly disturbed behaviour with potential risks for the mother and her newborn child. Women with bipolar disorder have a high risk of relapse related to childbirth, with up to 67% experiencing an episode in the postpartum period, including psychosis. There is much evidence for a relationship between sleep disruption and mood disorders in the perinatal period. Sleep loss has been suggested as a final common pathway in the development of psychosis in vulnerable women, i.e., women with bipolar disorder or a history of psychosis after childbirth. Prospective studies monitoring sleep and mood are scarce. The purpose of this study is to investigate the relationship between sleep disruption during pregnancy and the perinatal period and postpartum psychopathology in women with bipolar disorder. Methods/design: This is a prospective, observational, naturalistic, non-intervention study in pregnant women with an established diagnosis of bipolar disorder. The period of observation will be from week 13 of pregnancy until 12 weeks postpartum. Mood changes will be assessed using the Life Chart methodology throughout the whole study period. Sleep patterns will be assessed by a sleep diary and actigraphy in week 13 and week 26 of pregnancy and from two weeks before the expected delivery until four weeks after. Data will be collected on demographics, diagnosis, medical history, clinical management, clinical, functional, and obstetrical outcomes. In the weeks mentioned before additional data on mood and life-events will be collected. Primary outcomes are the occurrence of psychiatric symptoms during the first four weeks postpartum, and the number and type of any intervention started for impending psychiatric symptoms during the first four weeks postpartum. Discussion: We hypothesize that sleep disturbances during pregnancy and the perinatal period is associated with increased postpartum psychopathology. If so, intervention strategies aimed to improve sleep patterns may decrease the risk for postpartum psychopathology in women with bipolar disorder or a history of postpartum psychosis. Early treatment of sleep disturbance could be a cost-effective method for the prevention of postpartum mood disorders. This research protocol was approved by the Medical Ethics Review Committee of the VU University Medical Center (2012/3).

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Introduction: Prolonged mechanical ventilation after cardiac surgery is associated with prolonged length of stay and increased morbidity and mortality. Shorter postoperative ventilation times are accepted as a marker of quality. We implemented quality improvement efforts and methodology to reduce postoperative MV times for cardiac surgery patients in our cardiovascular intensive care unit. Methods: Baseline time-to-extubation data was obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD). An institutional unit-based data collection form was instituted to allow real-time assessment of extubation times. To inform quality improvement efforts, data was collected on demographics, surgery type, medical history, and mechanical ventilation times on all critically ill adult postoperative cardiac surgery patients for 2.5 months. Individual patient-specific times to extubation were placed in run charts. Improvement actions implemented included informal education of members of the healthcare team about prolonged extubation times, renewed focus on non-physician driven extubation protocol for weaning mechanical ventilation, and implementation time-oriented goals for extubation. Extubation-time data was analyzed in run charts to determine whether system changes had produced a change in median mechanical ventilation times. Standard run chart rules were used to determine whether a statistically significant shift in median mechanical ventilation times had occurred. Results: Baseline unit STS ACSD median postoperative mechanical ventilation time from January 2013 through March 2013 was 9.48 hours. After initiation of quality improvement efforts, run charts demonstrated a shift in median ventilation time to 4.7 hours. Conclusions: Median postoperative mechanical ventilation times for cardiac surgery patients were reduced after quality improvement efforts which included real-time data collection, informal education about mechanical ventilation times, emphasis of a non-physician driven mechanical ventilation weaning protocol, and time-oriented goals for extubation. System changes produced median extubation times lower than the STS ACSD 2012 national median postoperative ventilation time of 6.8 hours. Run chart methodology proved useful in monitoring system change during quality improvement efforts in this cardiovascular intensive care unit.

Network-Wide Statistical Modeling, Prediction, and Monitoring of Computer Traffic

Computer network use is becoming increasingly widespread, both in terms of number of users and variety of applications. To provide consistently high-quality service, network engineers and managers must monitor several aspects of the network, including traffic volumes on its links. As networks’ sizes expand, such monitoring becomes demanding in terms of resources required. Motivated by the prospect of monitoring only a small subset of links, this article explores the problem of using observed traffic measurements on selected links to predict the traffic on other, unobserved links. The characteristics of such unobserved links are learned through auxiliary data. Although more expensive to obtain, this extra dataset provides the necessary information to represent important structure in the network, and can significantly improve the results of prediction as compared with more naive approaches. In addition, we introduce an adjusted control chart methodology that shows possible applications of our prediction results in situations where all links may be observed. Supplementary materials are available online.

Economic-statistical design of variable parameters non-central chi-square control chart

Production processes are monitored by control charts since their inception by Shewhart (1924). This surveillance is useful in improving the production process due to increased stabilization of the process, and consequently standardization of the output. Control charts keep track of a few key quality characteristics of the outcome of the production process. This is done by means of univariate or multivariate charts. Small improvements in control chart methodology can have significant economic impact in the production process. In this investigation, we propose the monitoring of a single variable by means of a variable parameter non-central chi-square control chart. The design of the chart is accomplished by means of optimizing a cost function. We use here a simulated annealing optimization tool, due to the difficulty of classical gradient based optimization techniques to handle the optimization of the cost function. The results show some of the drawbacks of using this model.

Uncertainty and risk analysis of the Langrun Chinese GDP Forecast: Fan Charts revisited

In this paper, we develop a fan chart methodology for Chinese economic growth to incorporate uncertainty analysis into the gross domestic product growth forecast. Using the ‘Langrun Forecast’ project results exclusively, we estimate the density distribution for Chinese gross domestic product growth forecasts and build corresponding fan charts for the first time. Our analysis shows that the fan chart method effectively highlights the overall uncertainty and balance of risks surrounding Chinese gross domestic product growth, especially during the past international financial crisis between 2007 and 2009. Wallis' interval forecast test is conducted to evaluate the performance of the produced fan charts, and the results indicate that our forecasts perform well for the period being investigated.

A comparative study of phase II robust multivariate control charts for individual observations

Use of Hotelling's T2 charts with high breakdown robust estimates to monitor multivariate individual observations are the recent trend in the control chart methodology. Vargas (J. Qual. Tech. 2003; 35: 367-376) introduced Hotelling's T2 charts based on the minimum volume ellipsoid (MVE) and the minimum covariance determinant (MCD) estimates to identify outliers in Phase I data. Studies carried out by Jensen et al. (Qual. Rel. Eng. Int. 2007; 23: 615-629) indicated that the performance of these charts heavily depends on the sample size, amount of outliers and the dimensionality of the Phase I data. Chenouri et al. (J. Qual. Tech. 2009; 41: 259-271) recently proposed robust Hotelling's T2 control charts for monitoring Phase II data based on the reweighted MCD (RMCD) estimates of the mean vector and covariance matrix from Phase I. They showed that Phase II RMCD charts have better performance compared with Phase II standard Hotelling's T2 charts based on outlier free Phase I data, where the outlier free Phase I data were obtained by applying MCD and MVE T2 charts to historical data. Reweighted MVE (RMVE) and S-estimators are two competitors of the RMCD estimators and it is a natural question whether the performance of Phase II Hotelling's T2 charts with RMCD and RMVE estimates exhibits similar pattern observed by Jensen et al. (Qual. Rel. Eng. Int. 2007; 23: 615-629) in the case of MCD and MVE-based Phase I Hotelling's T2 charts. In this paper, we conduct a comparative study to assess the performance of Hotelling's T2 charts with RMCD, RMVE and S-estimators using large number of Monte Carlo simulations by considering different data scenarios. Our results are generally in favor of the RMCD-based charts irrespective of sample size, outliers and dimensionality of Phase I data. Copyright © 2010 John Wiley & Sons, Ltd.

Measuring safety and quality to improve clinical outcomes — current activities and future directions for the Australian Cardiac Procedures Registry

Routine monitoring of performance in the provision of cardiac services aids quality assurance and enables comparisons of performance to national and international standards. The Australasian Society of Cardiac and Thoracic Surgeons conducts a surgical registry that has grown from six hospitals participating in 2001 to 21 contributing in 2010. Variation in performance is monitored on a quarterly basis through the use of control chart methodology, and a peer-review mechanism and governance process for reporting have been established. Proposed future developments of the registry include its expansion to include interventional cardiology procedures, such as implantation of stents and cardiac devices, and a modular format, with the patient rather than the procedure being the key element of the system. An Australian Cardiac Procedures Registry will provide information to stakeholders, including consumers, clinicians, health funders and policymakers, on performance standards and quality of care of medical services affecting an ever-increasing number of Australians.

Kraepelin digitised: new technologies for monitoring the course of bipolar disorder

In this symposium we will present novel work on new technologies developed to facilitate the symptomatic monitoring of Bipolar disorder in the context of recent prospective studies (Judd et al. 2002, Post et al. 2003) that have investigated the subsyndromal and syndromal course of the disorder and have highlighted the chronicity, variability, and complex nature of Bipolar symptomatology. Emil Kraepelin’s need to map his clinical observations and to gather data in order to carefully characterize the episodic course of manic depressive illness led him to develop the first graphical life-chart for Bipolar patients. Many decades later paper-based life charting systems were developed to monitor bipolar disorder, including the ChronoSheet by Peter Whybrow and the Life Chart Methodology (NIMH-LCM) by Robert Post. Over the last 10 years these paper methodologies have been computerized, and we now have a number of different systems to assist the electronic monitoring of Bipolar disorder. In this symposium two complementary electronic systems will be presented (Moodchart and iMonitor) along with a brief overview of the research they have generated. Finally, the symposium will conclude with novel and still experimental research using actigraphic devices for monitoring the course as well as the activities of bipolar patients.

Enhancing adherence to mood charting with an online version of the NIMH Life Chart

Longitudinal mood instability is the essential feature of bipolar disorder, however most rating scales are cross sectional in nature, and focus on acute symptoms. By contrast, the NIMH Life Chart Methodology (LCM) characterizes in detail the severity, duration, and frequency of mood episodes. Unfortunately, adherence to daily rating tends to be low. Compared to the traditional paper chart, an online adaptation of the LCM that used links embedded in a daily email as the primary form of data entry substantially increased the number of days rated by a sample of patients with bipolar disorder. An analysis of the ways in which users interacted with the application found that manipulation of the user interface affected the number of days that were rated. Features of video games and commercial web sites designed to reinforce repeated long-term use can be adapted to therapeutic applications to support adherence. These features include content delivery, point accumulation, personalization, discovery, and reward.

The role of gender in single vs married individuals with bipolar disorder

Background Despite the importance of marriage as a source of social support, it has been largely neglected in studies of bipolar disorder; and differential effects on men and women have not been explored. Methods Data on episodes of depression, mania, and mixed states were collected for the previous 2 years from a sample of 282 bipolar individuals using the National Institute of Mental Health Life Chart Methodology. Results Effects unique to women included the following: Bipolar women were significantly more likely to be married. Married women had fewer episodes of depression during the past 2 years than never-married women, and the cumulative severity of depression was lower. There were no differences in diagnostic subtype or age of onset between married and never-married women. Among men, never-married men were more likely to have bipolar I disorder and had an earlier age of onset compared with married men. There were no differences between married and never-married men in frequency, duration, or severity of mood episodes. Conclusions Partner selection processes as they relate to bipolar disorder may be different for men and women. The bipolar I diagnostic subtype and early age of onset were associated with a lower likelihood of being married for men, but not for women. Marriage was associated with less depression in women during a 2-year period; but marital status was not associated with disease course differences in men, suggesting that women may be more sensitive to the positive effects of social support available within a stable marital relationship.

A randomized comparison of online and paper mood charts for people with bipolar disorder

Background Longitudinal mood instability is the essential feature of bipolar disorder, however most rating scales are cross sectional in nature, and focus on acute symptoms. By contrast, the NIMH Life Chart Methodology (LCM) characterizes in detail the severity, duration, and frequency of mood episodes. Adherence to daily rating, however, tends to be low. In this study an online version of the LCM, designed to enhance adherence, was compared to the standard paper version. Methods Patients from a mood disorders specialty clinic were randomized to the standard LCM or an online, open-source adaptation. The online version used hypertext links embedded in a daily email as the primary rating interface. Participants rated for 90 days. The total number of days rated and the number of days with complete data were compared for the two groups. Results Forty-eight patients participated in the study. The online group rated approximately twice as many days compared to the standard group (44.3 versus 20.4, p = .029). The online group also entered complete data for a larger portion of days (55.2% versus 27.7%, p = .039). Limitations This was a small, short-term study. The implications for longer-term rating are unclear. Conclusions Despite the advantages of documenting mood fluctuation on a daily basis, the LCM is not commonly used, in part because ensuring adequate adherence can be resource intensive. An easily accessible online adaptation that utilizes email checking behavior can make this tool available to a wider range of patients.

The demerit‐based control chart for trinomial distribution

PurposeThe purpose of this paper is to investigate the properties of the classical goodness of fit test statistics X2, G2, GM2, and NM2 in testing quality of process represented as the trinomial distribution with dip null hypothesis and to devise a control chart for the trinomial distribution with dip null hypothesis based on demerit control chart.Design/methodology/approachThe research involves the linear form of the test statistics, the linear function of counts since the marginal distribution of the counts in any category is binomial or approximated Poisson, in which the uniformly minimum variance unbiased estimator is the linear function of counts. A control chart is used for monitoring student characteristics in Thailand. The control chart statistics based on an average of the demerit value computed for each student as a weighted average lead to a uniformly most powerful unbiased test marginally. The two‐sided control limits were obtained using percentile estimates of the empirical distribution of the averages of the demerit.FindingsThe demerit control chart of the weight set (1, 25, 50) shows a generally good performance, robust to direction of out‐of‐control, mostly outperforms the GM2 and is recommended. The X2, NM2 are not recommended in view of inconsistency and bias. The performance of the demerit control chart of the weight set (1, 25, 50) does not dramatically change between both directions.Practical implicationsNone of the multivariate control charts for counts presented in the literature deals with trinomial distribution representing the practical index of the quality of the production/process in which the classification of production outputs into three categories of “good”, “defective”, and “reworked” is common. The demerit‐based control chart presented here can be applied directly to this situation.Originality/valueThe research considers how to deal with the trinomial distribution with dip null hypothesis which no research study so far has presented. The study shows that the classical Pearson's X2, Loglikelihood, modified Loglikelihood, and Neyman modified X2 could fail to detect an “out‐of‐control”. This research provides an alternative control chart methodology based on demerit value with recommended weight set (1, 25, 50) for use in general.

Monitoring service quality with residuals control charts

Purpose – The purpose of this paper is to devise a robust statistical process control methodology that will enable service managers to better monitor the performance of correlated service measures.Design/methodology/approach – A residuals control chart methodology based on least absolute value regression (LAV) is developed and its performance is compared to a traditional control chart methodology that is based on ordinary least squares (OLS) regression. Sensitivity analysis from the goal programming formulation of the LAV model is also performed. The methodology is applied in an actual service setting.Findings – The LAV based residuals control chart outperformed the OLS based residuals control chart in identifying out of control observations. The LAV methodology was also less sensitive to outliers than the OLS approach.Research limitations/implications – The findings from this study suggest that the proposed LAV based approach is a more robust statistical process control method than the OLS approach. In a...

Assessing the performance of a consultant anaesthetist by control chart methodology*

The performance of trainee anaesthetists has been assessed by control chart methodology, but while assessment of consultants' performance has been suggested, published reports are rare. In order to test the value of control charts, I monitored my insertion of arterial and central venous cannulae over 3 years, documenting success or failure both for the first pass of the needle and for the intended site of cannulation. The resultant control charts clearly show episodes of changed performance. It was necessary to modify the technique used to assess trainees, specifically with relation to definitions of success, failure and 'acceptable' failure rates. The information obtained from these charts is well suited to inform an appraisal or revalidation discussion with both reflective and assessment elements.