Codebook Research Articles

Can ChatGPT Support Clinical Coding Using the ICD-10-CM/PCS?

Introduction: With the growing development and adoption of artificial intelligence in healthcare and across other sectors of society, various user-friendly and engaging tools to support research have emerged, such as chatbots, notably ChatGPT. Objective: To investigate the performance of ChatGPT as an assistant to medical coders using the ICD-10-CM/PCS. Methodology: We conducted a prospective exploratory study between 2023 and 2024 over 6 months. A total of 150 clinical cases coded using the ICD-10-CM/PCS, extracted from technical coding books, were systematically randomized. All cases were translated into Portuguese (the native language of the authors) and English (the native language of the ICD-10-CM/PCS). These clinical cases varied in complexity levels regarding the quantity of diagnoses and procedures, as well as the nature of the clinical information. Each case was input into the 2023 ChatGPT free version. The coding obtained from ChatGPT was analyzed by a senior medical auditor/coder and compared with the expected results. Results: Regarding the correct codes, ChatGPT’s performance was higher by approximately 29 percentage points between diagnoses and procedures, with greater proficiency in diagnostic codes. The accuracy rate for codes was similar across languages, with rates of 31.0% and 31.9%. The error rate in procedure codes was substantially higher than that in diagnostic codes by almost four times. For missing information, a higher incidence was observed in diagnoses compared to procedures of slightly more than double the comparative rates. Additionally, there was a statistically significant excess of codes not related to clinical information, which was higher in procedures and nearly the same value in both languages under study. Conclusion: Given the ease of access to these tools, this investigation serves as an awareness factor, demonstrating that ChatGPT can assist the medical coder in directed research. However, it does not replace their technical validation in this process. Therefore, further developments of this tool are necessary to increase the quality and reliability of the results.

Assessment of Community Knowledge, Attitudes, and Perceptions Toward Effluent Quality Discharged from the Shirere Wastewater Treatment Plant to the Isiukhu River, Kakamega County, Kenya

For waste removal, advanced infrastructural technologies can be adopted in the drainage channels of effluents into water bodies though they are limited and scarce. The aim of the study was to asses community knowledge, attitude and perception towards effluent quality discharged from Shirere wastewater treatment plant up to river Isiukhu. Correlation and descriptive survey were the main research approaches adopted. The measurement of the knowledge, perception and attitude was limited to only the community members, as well as Kakamega County Water and Sanitation Company (KACWASCO) staff members. The study was anchored by the risk management theory to demonstrate the vulnerability of community hazards like water pollution. The social-economic sampling approaches applied were stratified for the community members and random for the KACWASCO workers. The population targeted was eighty community members and four KACWASCO staff members. The questionnaires were pretested through a pilot study to ascertain their reliability. This pre-test was conducted at a different Waste Water Treatment Plant (WWTP) at Nabongo. The Pearson coefficient (r) was used to compute the correlation coefficient between the two test scores. Data was analyzed using regression and correlation methods. For socio-economic, reliability test was administered by use test- retest method. A code book was prepared and scores of the first test correlated with scores of the second test, and Pearson product moment of correlation was computed using SPSS software version 21.0. By applying the analysis of variance (ANOVA), researcher was able to determine whether differences observed between groups are likely due to actual variations in their perceptions or simply due to chance. From the reliability test, all of the variables obtained had Cronbach's Alpha greater than 0.7, indicating that they met the necessary 0.7 for data internal consistency. The Bartlett's test for validity was examined using the chi-square test, which revealed that all of the variables were significant at the 5% (0.000) level of significance. Only 82 of the 84 questionnaires provided to the sampled respondents (KACWASCO staffs and community members) were filled out and returned in this study. From the study findings the value of R-square was 0.429. The ANOVA test indicated that in this model the independent variable namely; knowledge of the residents is important in predicting of waste water treatment as indicated by significance value=0.002 which is less than 0.05 level of significance (p=0.002 < 0.05). Additionally, the response under attitude and perception, the value of R-Square was 0.045 which implied that, 4.5% of variation of Wastewater Treatment Plant in Shirere was explained by attitude and perception of the residents within the area. The study also revealed that attitude and perception of the residents in Shirere had a significant influence on wastewater treatment at Shirere in Kakamega County (t-statistic = 25.674, p-value = ). Therefore, it was concluded that, at 5% level of significance, indicating that community knowledge, perception and attitude had a positive influence on waste water treatment at Shirere in Kakamega County. Likewise, for every unit increase in attitude of the residents there was a corresponding increase in wastewater treatment at Shirere in Kakamega County by 0.628. The study recommended that, the community members need more sensitization on matters pollution as revealed by this study.

Clinical indications associated with new opioid use for pain management in the United Kingdom: using national primary care data.

Prescription opioids for noncancer pain in the United Kingdom have increased over the past 2 decades, alongside associated harms. Policies addressing opioid prescribing must be tailored to individual patient needs with specific disease systems. The aim of this study was to evaluate clinical conditions associated with new opioid initiation in noncancer pain using nationally representative UK data. Primary care electronic health records from January 1, 2006, to September 31, 2021, were used from the Clinical Research Practice Datalink to identify incident opioid prescriptions. Patient histories were reviewed using code lists for opioid-related conditions with a 5-year look-back for chronic conditions and a 1-year look-back for surgical indications before opioid initiation. In total, 3,030,077 new opioid use episodes in 2,027,402 patients were identified, with 61% being women, 77% aged 45 years and older, and 48% from the highest deprivation quintile. Ten systems associated with opioid initiation were identified, which were not mutually exclusive, as patients could have opioids prescribed for multiple indications. The most common were musculoskeletal (80.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.9%), and postsurgical indications (5.5%). Osteoarthritis (60.7%) and low back pain (41.0%) were the most frequent musculoskeletal conditions. Orthopedic surgeries accounted for 41.2% of all postsurgical indications. This is the first study in the United Kingdom evaluating large-scale national data to assess indications associated with opioid initiation. Nearly 3 quarters of new opioid prescriptions for noncancer pain were in patients with musculoskeletal conditions, often for conditions with limited evidence for opioid efficacy. These findings could inform targeted interventions and future policies to support nonpharmacological interventions in the most common conditions where opioid harms outweigh benefits.

A Critical Comparison of Kautilya's 'Arthashastra' and Machiavelli's 'The Prince', Their Political Theories and Philosophies

Kautilya’s Arthashastra was translated to English in the year 1915, since then its comparison with Machiavelli started. Chanakya is credited with the creation of Arthashastra, a magnum opus on statecraft, law, military, and other matters of the state. The Arthashastra is the oldest book on political science and political ethics, and he introduced many other prominent issues to be kept in mind compared to Machiavelli. Machiavelli only concentrates on political and fiscal matters, Kautilya writes about the importance of land settlements, promotion of economic activity, rules of society, construction of infrastructure, defence, and communication. He has given a list of behavioral codes for ministers, king, and civilians. There is mention of diverse levels of administration, various departments and the roles for the officials are clearly defined. And the entire administration was based on the foundation of ‘Dharma’. Arthashastra is a comprehensive, coherent, original document while on the other hand Machiavelli was seeking a job and he sent his manuscript with job application. Consequently, he covered a very few topics and did not analyze any topic in depth. Though written and complied centuries apart and prior to Machiavelli’s Prince, The Arthashastra is much more detailed and complete text on state craft which is relevant even today. Some researchers have even gone to the extent of saying that, comparing Machiavelli’s Prince to Kautilya’s Arthashastra is like comparing a candlelight to that of sunlight.

Development of ethical codes for instructors engaged in distance education: a Delphi study

ABSTRACT Ethical codes are written documents that delineate a set of rules and principles that guide the duties and responsibilities of professionals within a professional organization from an ethical perspective. The research aims to develop an ethical code framework for instructors engaged in distance education. The Delphi, a qualitative research method, was employed to achieve this aim. The study included 22 distance education experts, selected via purposive sampling. The Delphi technique, conducted in three rounds, commenced with an evaluation of the ethical dimensions of distance education. In the study’s second phase, we invited participants to suggest additional ethical codes for the agreed-upon dimensions. We collected the suggestions and agreed on specific ethical code items in the third round. The researchers thus established the final form of the ethical code list. This process resulted in developing an ethical code framework for instructors engaged in distance education. The framework comprises sixdimensions: Instructional Design (ID), Social Interaction (SI), Content Provision (CP), Technology Usage (TU), Management (M), and Assessment and Evaluation (AE). It includes 62 ethical code items. The study demonstrates that the ethical code dimensions align with the roles of online instructors, as described in the relevant literature. This alignment substantiates the ethical code framework's validity and reliability.

Implementation of a peer-delivered opioid overdose response initiative in New York City emergency departments: Insight from multi-stakeholder qualitative interviews

BackgroundEmergency departments (EDs) are critical touchpoints for overdose prevention efforts. In New York City (NYC), the Health Department's Relay initiative dispatches trained peer “Wellness Advocates” (WAs) to engage with patients in EDs after an overdose and for up to 90 days subsequently. Interest in peer-delivered interventions for patients at risk for overdose has grown nationally, but few studies have explored challenges and opportunities related to implementing such interventions in EDs. MethodsWe conducted in-depth interviews with Relay WAs, ED patients, and ED providers across 4 diverse NYC EDs. Sampling was purposeful and continued until theoretical saturation was reached. Interviews followed a semi-structured interview guide based on key domains from the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted by telephone or web conferencing; audio recordings were professionally transcribed. The study utilized rapid qualitative analysis using template summaries and summary matrices followed by line-by-line coding conducted independently by 3 researchers, then discussed and harmonized at group coding meetings. Coding was both inductive (using an a priori code list based on CFIR domains and study goals) and deductive (new codes allowed to emerge from transcripts). Dedoose software was used for data organization. ResultsWe conducted 32 in-depth interviews (10 WAs, 12 patients, 10 ED providers). Four overarching themes emerged: 1) EDs are characterized by multiple competing demands (e.g., related to provider time and physical space), underscoring the utility of Relay and leading to some practical challenges for its delivery; 2) There is a strong role distinction of WAs as peers with lived experience; 3) ED providers value Relay, even though they have a limited understanding of its full scope and outcomes; 4) While the role of structural factors (e.g., homelessness and unstable housing) is recognized, responsibility is often placed on patients for controlling their own success. ConclusionsWe identified four themes that shed new light on the implementation of peer-based overdose prevention programs in EDs. Our findings highlight unique ED inner and outer setting factors that may impact program implementation and effectiveness. The findings provide actionable information to inform implementation of similar programs nationally.

Evaluating the impact of occupational noise exposure on workplace fatal and nonfatal injuries in the U.S. (2006–2020)

ObjectivesThis study assessed the relationship between occupational noise exposure and the incidence of workplace fatal injury (FI) and nonfatal injury (NFI) in the United States from 2006 to 2020. It also examined whether distinct occupational and industrial clusters based on noise exposure characteristics demonstrated varying risks for FI and NFI. MethodsAn ecological study design was utilized, employing data from the U.S. Bureau of Labor Statistics for FI and NFI and demographic data, the U.S. Census Bureau for occupation/industry classification code lists, and the U.S./Canada Occupational Noise Job Exposure Matrix for noise measurements. We examined four noise metrics as predictors of FI and NFI rates: mean Time-Weighted Average (TWA), maximum TWA, standard deviation of TWA, and percentage of work shifts exceeding 85 or 90 dBA for 619 occupation-years and 591 industry-years. K-means clustering was used to identify clusters of noise exposure characteristics. Mixed-effects negative binomial regression examined the relationship between the noise characteristics and FI/NFI rates separately for occupation and industry. ResultsAmong occupations, we found significant associations between increased FI rates and higher mean TWA (IRR: 1.06, 95% CI: 1.01–1.12) and maximum TWA (IRR: 1.10, 95% CI: 1.07–1.14), as well as TWA exceedance (IRR: 1.04, 95% CI: 1.01–1.07). Increased rates of NFI were found to be significantly associated with maximum TWA (IRR: 1.06, 95% CI: 1.04–1.09) and TWA exceedance (IRR: 1.03, 95% CI: 1.01–1.05). In addition, occupations with both higher exposure variability (IRR with FI rate: 1.49, 95% CI: 1.23–1.80; IRR with NFI rate: 1.40, 95% CI: 1.14–1.73) and higher level of sustained exposure (IRR with FI rate: 1.27, 95% CI: 1.12–1.44; IRR with NFI rate: 1.21, 95% CI: 1.05–1.39) were associated with higher rates of FI and NFI compared to occupations with low noise exposure. Among industries, significant associations between increased NFI rates and higher mean TWA (IRR: 1.05, 95% CI: 1.02–1.08) and maximum TWA (IRR: 1.06, 95% CI: 1.04–1.08) were observed. Unlike the occupation-specific analysis, industries with higher exposure variability and higher sustained exposures did not display significantly higher FI/NFI rates compared to industries with low exposure. ConclusionsThe results suggest that occupational noise exposure may be an independent risk factor for workplace FIs/NFIs, particularly for workplaces with highly variable noise exposures. The study highlights the importance of comprehensive occupational noise assessments.

The phenomenon of yoga in the imagination of Turkish nursing students: "The way to place goodness in the heart"

BackgroundThe aim of the research is to shed light on the experiences of a group of nursing students enrolled in a yoga elective course who practiced yoga regularly for 14 weeks, regarding yoga and the phenomenon of doing yoga, with a qualitative approach.MethodsThis qualitative study was conducted at a public university in Izmir, Turkey. The study sample consisted of 61 students enrolled in the 1st-year yoga course at the Department of Nursing, Faculty of Health Sciences. Except for two students, 59 of them participated in the study. Participants attended a face-to-face yoga course once a week for 1.5 h over a 14-week period. Each session comprised 30 min of theoretical instruction and 60 min of practice. In data collection, an interview form containing five questions was used to understand nursing students' experiences and thoughts about practicing yoga. In addition, A4 sized papers in different colors were presented to the participants. The participants were asked to draw and/or cut a shape by choosing the paper in the color that most evokes yoga. Then they were asked to explain why they chose this color and why they drew this shape. Participants were given one hour. After the data were collected, the pictures drawn by the participants and their descriptions of their drawings were transferred to the computer and included in the analysis. Qualitative data were hand-coded by the researchers. Within in-vivo coding, code names were formed from the participants' expressions. The findings analyzed by content analysis were interpreted with the literature under the themes by presenting quotations.ResultsIt was determined that the participants used nature figures (sun, cloud, tree, sky, flower) (f = 75), people doing yoga (f = 12), and sound, light and other figures (bird sound, wave sound, candle, light bulb, traffic light, heart, eye, left key, peace, swing, India, circle, etc.) (f = 29) in the shapes they drew and cut out on A4 sized papers in different colors to describe their experiences and thoughts about practicing yoga. The participants mostly chose blue-green-yellow colors (n = 41). With qualitative question analysis, a list of codes was created from the answers given by the students to the questions for the phenomenon of “doing yoga” (number of codes = 98). After the analysis of the data, four categories were reached. The category names and frequency numbers explaining the phenomenon of practicing yoga were distributed as “symbol of health and serenity (f = 345)”, “the way to place goodness in your heart (f = 110)”, “the most effective way to meet the self (f = 93)” and “no guarantee of relaxation (f = 71)”, respectively.ConclusionsThe results indicate that yoga is perceived by nursing students as a multifaceted practice that evokes a range of emotional and physical responses. Most participants associate yoga with symbols of health, serenity, and self-awareness, often using natural elements and blue-green-yellow the colors to represent these feelings. However, there is also recognition that yoga may not guarantee relaxation for everyone, as some students reported difficulties in meditation, physical discomfort, and challenges in focusing. The study highlights the variability in how individuals experience yoga, emphasizing both its positive effects on well-being and the potential challenges in practice. These findings suggest that while yoga is widely valued for its calming and health-promoting benefits, it may not be universally effective in achieving relaxation or mindfulness.

Enhancing the usability of health data for inequalities research: a UK quality improvement project and code list curation.

Objective and ApproachPrimary care datasets provide a rich source of information for inequalities research; however, the value derived from these depends largely on the comprehensiveness of the code lists used by researchers. To date, no standardised code list for inequalities research has been developed. The aim of this project was to develop a comprehensive code list for groups of interest to inequalities research, namely: people with learning disabilities (LDs), people with severe mental illness (SMI), people from ethnic minority groups, and people who are transgender. Existing code lists were extracted from the Clinical Practice Research Datalink (CPRD) Bibliography (the largest research dataset in the UK), and four UK code list repositories: OpenCodelists, Health Data Research UK, University of Cambridge, and London School of Hygiene and Tropical Medicine. Comprehensive code lists were then curated through collation and removal of duplicates. Results16 code lists were identified for LDs, 18 for SMI, 16 for ethnicity, and 2 for transgender. From these, 661, 733, 346 and 68 unique codes were identified, respectively. Preliminary testing of the curated code lists, in a CPRD dataset, indicated that the number of individuals belonging to these groups was increased by 90% (compared to the original code list). Conclusions and ImplicationsOur findings suggest that the curated code lists improved data capture. These lists now need to be validated by healthcare specialists, before being made publicly available. The inclusion of code-specific definitions will enable international researchers to adapt the code lists to their medical systems.

Evolving the HDRUK Phenotype Library: Phenotype Creation and Editing

ObjectiveThe HDRUK Phenotype Library (phenotypes.healthdatagateway.org) shares definitions used to measure concepts of interest (such as diagnoses or treatments) within health datasets. It already holds more than 1000 phenotypes, with researchers able to contribute their work via an API. We aimed to create a more user-friendly method of contributing to the Library. ApproachWe designed a phenotype creation workflow enabling users to create and submit new content via web interface. Goals included clarity and ease of use for a broad range of users. ResultsA home page shows researchers’ own content. Researchers can create new phenotypes using a web form, entering metadata such as name, authors, description, and publications. Code lists are defined via one or more rules, including search terms or referring to another phenotype, or by CSV upload. Users can make their phenotypes accessible to a research group or to all authenticated users, as well as publish content on the web. Publication requests are reviewed to ensure content is complete and appropriate. Editing, with full history and version control, is also supported. ConclusionsWe implemented and released the new features. We are currently engaging researchers to get feedback and invite content submission. ImplicationsThe benefit of tools to support research transparency and repeatability is only realized when they are adopted. We hope that a GUI to support phenotype creation will broaden the Library’s user base help it serve as an enabler of higher-quality, more efficient research across the worldwide health data research community.

A Qualitative Assessment of Reasons for Living and Dying in the Context of Feeling Trapped Among Adults in the United Kingdom

Objective Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals’ self-described RFL and RFD in the context of suicidal thinking and behaviors. Method Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. Results The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. Conclusions Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

Toward Reliable Symptom Coding in Electronic Health Records for Symptom Assessment and Research: Identification and Categorization of International Classification of Diseases, Ninth Revision, Clinical Modification Symptom Codes.

To date, symptom documentation has mostly relied on clinical notes in electronic health records or patient-reported outcomes using disease-specific symptom inventories. To provide a common and precise language for symptom recording, assessment, and research, a comprehensive list of symptom codes is needed. The International Classification of Diseases, Ninth Revision or its clinical modification ( International Classification of Diseases, Ninth Revision, Clinical Modification ) has a range of codes designated for symptoms, but it does not contain codes for all possible symptoms, and not all codes in that range are symptom related. This study aimed to identify and categorize the first list of International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes for a general population and demonstrate their use to characterize symptoms of patients with type 2 diabetes mellitus in the Cerner database. A list of potential symptom codes was automatically extracted from the Unified Medical Language System Metathesaurus. Two clinical experts in symptom science and diabetes manually reviewed this list to identify and categorize codes as symptoms. A total of 1888 International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes were identified and categorized into 65 categories. The symptom characterization using the newly obtained symptom codes and categories was found to be more reasonable than that using the previous symptom codes and categories on the same Cerner diabetes cohort.

Standardization of coding definitions for sickle cell disease complications: A systematic literature review.

Sickle cell disease (SCD) affects all organ systems and is characterized by numerous acute and chronic complications and comorbidities. Standardized codes are needed for complications/comorbidities used in real-world evidence (RWE) studies that rely on administrative and medical coding. This systematic literature review was conducted to produce a comprehensive list of complications/comorbidities associated with SCD, along with their diagnosis codes used in RWE studies. A search in MEDLINE and Embase identified studies published from 2016 to 2023. Studies were included if they were conducted in US SCD populations and reported complications/comorbidities and respective International Classification of Diseases, Clinical Modification (ICD-CM) codes. All identified complications/comorbidities and codes were reviewed by a certified medical coding expert and hematologist. Of 1851 identified studies, 39 studies were included. The most reported complications/comorbidities were stroke, acute chest syndrome, pulmonary embolism, venous thromboembolism, and vaso-occlusive crisis. Most of the studies used ICD-9-CM codes (n = 21), while some studies used ICD-10-CM codes (n = 3) or both (n = 15), depending on the study period. Most codes reported in literature were heterogeneous across complications/comorbidities. The medical coding expert and hematologist recommended modifications for several conditions. While many studies we identified did not report their codes and were excluded from this review, the studies with codes exhibited diverse coding definitions. By providing a standardized set of diagnosis codes that were reported by studies and reviewed by a coding expert and hematologist, our review can serve as a foundation for accurately identifying complications/comorbidities in future research, and may reduce heterogeneity, enhance transparency, and improve reproducibility. Future efforts focused on validating these code lists are needed.

Complementary and integrative medicine - Resolving situations of reduced remuneration for additional work under the SwissDRG system

Aim of the studyComplementary and integrative medicine (CIM) has been increasingly recognized as offering promising treatment adjunctions in various clinical settings, even amongst patients with serious, chronic, or recurrent illness. Today, only few tertiary care facilities in Switzerland offer dedicated CIM services for inpatients. The aim of the present study was to evaluate whether CIM services for complex medical conditions are adequately valued by the national inpatient SwissDRG reimbursement system. MethodsA simulation was performed by adding a specific code of the Swiss classification of interventions (CHOP) to the list of codes of each patient who received CIM therapies at the Lausanne University Hospital (CHUV) in 2021. This code is to be used when CIM services are provided. Hitherto, it was not entered due to a lack of specific documents justifying the resources used. The analysis focused on the impact of adding this CIM CHOP code on the Swiss Diagnosis Related Group (DRG) reimbursement. ResultsIn total, 275 patients received a CIM therapy in 2021. The addition of the CIM CHOP code 99.BC.12 (10–25 CIM sessions per stay) resulted in a simulated loss of income of CHF 766 630 for the hospital, while the net real result is already negative by more than CHF 6 million. The DRGs positively impacted by the addition of CIM CHOP code 99.BC.12 had a mean (SD) cost weight (CW) of 1.014 (0.620), while the DRGs negatively impacted had a mean (SD) CW of 3.97 (2.764) points. ConclusionIt is necessary to quickly react and improve the incentives contained in the grouping algorithm of the prospective payment system, whose effects can threaten the provision of adequate medical care to the patients despite suitable indications and potential for cost-savings.

"I Felt Like I Mattered": Caring is a key ingredient of collaborative care for chronic illness.

To identify perceptions and experiences related to caring science and collaborative care in intervention participants of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) study, a randomized, multi-site clinical trial for patients with chronic heart failure and reduced health status. Forty-five participants completed semi-structured, telephone interviews with a focus on intervention components, impact of the intervention on participants' lives, and recommendations for intervention change. Data were analyzed using an inductive content analysis approach focusing on the presence and frequency of text to identify patterns, categories, and themes across participants without an a priori code book. The validity of the identified categories was enhanced through triangulation. Three themes were identified: (1) intervention providers' caring/helping attitude and caring/helping communication; (2) care team availability to respond to concerns or questions; and (3) help with understanding and navigating the healthcare system. Patients highly value caring attitudes and communication, availability, and empowerment to understand and navigate healthcare systems. These attitudes and behaviors may be important mediators of the success of collaborative care programs. These are consistent with the theory of caring science, a framework that is relevant more broadly to patient-centered and team-based care models.

A protocol for neoWONDER: Neonatal whole population data linkage to improve long-term health and wellbeing of preterm and sick babies.

Early-life medical and surgical interventions in babies born preterm and/or with surgical conditions influence later life health and educational outcomes. Obtaining long-term outcomes post-discharge to evaluate the impact of interventions is complex, expensive, and burdensome to families. Linkage of routinely collected data offers a feasible and cost-effective solution. The NeoWONDER research programme aims to describe the short and long-term health and educational outcomes for babies born preterm and/or with surgical conditions and evaluate the impact of neonatal care and interventions on later health and educational outcomes. We will include babies who received care in neonatal units in England and Wales, born between 2007-2020 with a gestational age below 32 weeks (approximately 100,000), and/or born between 2012-2020 (all gestations) with any of six surgical conditions: necrotising enterocolitis, Hirschsprung's disease, gastroschisis, oesophageal atresia, congenital diaphragmatic hernia, and posterior urethral valves (approximately 8,000). A detailed list of surgical condition codes is shown in S3 File. We will obtain long-term health and education outcomes through linkage of the National Neonatal Research Database, which contains routine data for all babies admitted to NHS neonatal units, to other existing health and educational datasets. For England, these are: Hospital Episode Statistics, the Office for National Statistics, Mental Health Services Dataset, Paediatric Intensive Care Audit Network, National Pupil Database; and for Wales, the Secure Anonymised Information Linkage databank. Analysis will be undertaken on de-identified linked datasets. Outcomes of interest for health include mortality, hospital admissions, diagnoses indicative of neurodisability and/or chronic illness, health care utilisation; and for education are attainment (using national curriculum assessments), school absence and special educational needs status.

Derivation and Validation of ICD-10 Codes for Identifying Incident Stroke

Claims data with International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes are routinely used in clinical research. However, the use of ICD-10 codes to define incident stroke has not been validated against expert-adjudicated outcomes in the US population. To develop and validate the accuracy of an ICD-10 code list to detect incident stroke events using Medicare inpatient fee-for-service claims data. This cohort study used data from 2 prospective population-based cohort studies, the Atherosclerosis Risk in Communities (ARIC) study and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, and included participants aged 65 years or older without prior stroke who had linked Medicare claims data. Stroke events in the ARIC and REGARDS studies were identified via active surveillance and adjudicated by expert review. Medicare-linked ARIC data (2016-2018) were used to develop a list of ICD-10 codes for incident stroke detection. The list was validated using Medicare-linked REGARDS data (2016-2019). Data were analyzed from September 1, 2022, through September 30, 2023. Stroke events detected in Medicare claims vs expert-adjudicated stroke events in the ARIC and REGARDS studies. The main outcomes were sensitivity and specificity of incident stroke detection using ICD-10 codes. In the ARIC study, there were 110 adjudicated incident stroke events among 5194 participants (mean [SD] age, 80.1 [5.3] years) over a median follow-up of 3.0 (range, 0.003-3.0) years. Most ARIC participants were women (3160 [60.8%]); 993 (19.1%) were Black and 4180 (80.5%) were White. Using the primary diagnosis code on a Medicare billing claim, the ICD-10 code list had a sensitivity of 81.8% (95% CI, 73.3%-88.5%) and a specificity of 99.1% (95% CI, 98.8%-99.3%) to detect incident stroke. Using any diagnosis code on a Medicare billing claim, the sensitivity was 94.5% (95% CI, 88.5%-98.0%) and the specificity was 98.4% (95% CI, 98.0%-98.8%). In the REGARDS study, there were 140 adjudicated incident strokes among 6359 participants (mean [SD] age, 75.8 [7.0] years) over a median follow-up of 4.0 (range, 0-4.0) years. More than half of the REGARDS participants were women (3351 [52.7%]); 1774 (27.9%) were Black and 4585 (72.1%) were White. For the primary diagnosis code, the ICD-10 code list had a sensitivity of 70.7% (95% CI, 63.2%-78.3%) and a specificity of 99.1% (95% CI, 98.9%-99.4%). For any diagnosis code, the ICD-10 code list had a sensitivity of 77.9% (95% CI, 71.0%-84.7%) and a specificity of 98.9% (95% CI, 98.6%-99.2%). These findings suggest that ICD-10 codes could be used to identify incident stroke events in Medicare claims with moderate sensitivity and high specificity.

Development of a harmonized and risk-based code system for post-mortem inspection of broilers

In most European countries, findings detected at post-mortem inspection (PMI) of broilers at slaughter are registered using national or regional code systems. The aim of this study was to map and compare existing national broiler PMI code systems in Europe and to suggest a new harmonized and risk-based code set intended to be interpreted in the same way in all countries. Information about the code systems, condemnation criteria, and the proportion of unfit broiler carcasses in 2022, as well as reasons justifying condemnation, were collected from nine European countries through an online survey. The reasons for declaring meat as unfit for human consumption were divided into food safety, meat quality, broiler health, or broiler welfare. The data were analyzed, and a risk-based code set consisting of 13 codes was developed. Ten of these new codes cover 80% of all condemnations listed in the data retrieved from the countries in the study. The remaining three codes are indicators of broiler welfare. The results were presented in the form of spider diagrams, indicating massive differences between the countries. Harmonization of the code list and the associated decision criteria will allow PMI to be conducted in the same way in different abattoirs and countries. This standardization of the PMI of broilers will enable detailed analysis of PMI results for further use in risk-based meat safety assurance systems and the implementation of computer-based vision systems at PMI in the future.

Harnessing ChatGPT for Thematic Analysis: Are We Ready?

ChatGPT (OpenAI) is an advanced natural language processing tool with growing applications across various disciplines in medical research. Thematic analysis, a qualitative research method to identify and interpret patterns in data, is one application that stands to benefit from this technology. This viewpoint explores the use of ChatGPT in three core phases of thematic analysis within a medical context: (1) direct coding of transcripts, (2) generating themes from a predefined list of codes, and (3) preprocessing quotes for manuscript inclusion. Additionally, we explore the potential of ChatGPT to generate interview transcripts, which may be used for training purposes. We assess the strengths and limitations of using ChatGPT in these roles, highlighting areas where human intervention remains necessary. Overall, we argue that ChatGPT can function as a valuable tool during analysis, enhancing the efficiency of the thematic analysis and offering additional insights into the qualitative data. While ChatGPT may not adequately capture the full context of each participant, it can serve as an additional member of the analysis team, contributing to researcher triangulation through knowledge building and sensemaking.

A qualitative inquiry into the lived experiences of menstrual health and hygiene in the transgender and non-binary people in urban areas of India

Significance Most global research on menstrual health and hygiene (MHH) focuses on cisgender women and girls, with limited evidence on the experiences of transgender and non-binary (TNB) people. This study aimed to document the lived experiences of menstruation management among TNB people in urban India. Methods We conducted 13 semi-structured interviews with TNB adults aged 19–40 years in three major Indian cities in collaboration with community organizations. We asked participants to share their experiences of managing menstruation in multiple spaces of life, e.g. at home, school, workplace, and other public spaces. Interviews were audio recorded, transcribed, de-identified, and cleaned. After a deductive and inductive process of developing a code book, we coded transcripts and developed code summaries to identify emergent themes. Results We identified three major themes in MHH for TNB urban Indians: (i) gendering of menstruation, (ii) navigating physical aspects of menstruation, and (iii) challenges beyond bleeding. ‘Gendering of menstruation’ shaped overall experiences of MHH among participants. Gendered expectations upon menarche triggered gender dysphoria. Participants reported having little knowledge about menstruation prior to menarche, which led to a state of confusion and shame, and exacerbated their dysphoria from gendering of norms around menstruation. ‘Navigating physical aspects of menstruation’ was less challenging in familiar, private surroundings, however, accessing public spaces and bathrooms remained a major challenge and stressor. Though many participants reported undergoing hormonal replacement therapy (HRT) in part to suppress menstruation, they continued experiencing menstrual symptoms which triggered continued dysphoria. Participants reported facing ‘challenges beyond bleeding’ which included burden of multiple diseases, mis-gendered healthcare services, and lack of social support. Discussion Documenting the lived experiences of menstrual health and hygiene among TNB people supports the call to ‘de-gender’ menstruation. Magnifying the voices and lived experienced of TNB people can bolster the development of effective interventions to enhance their wellbeing.