Coding Schema Research Articles

Health information exchange and 42 CFR part two: Incorporating the voice of people with histories of substance use disorder

IntroductionWe set out to understand patient attitudes and concerns about sharing information about substance use disorder (SUD) history through a Health Information Exchange (HIE), in the context of 42 CFR Part 2. MethodsThe study conducted semi-structured qualitative interviews of people with SUD history, recruited through an association of recovery communities in Rhode Island. Interviews were recorded and transcribed. Two Research Assistants coded the interviews using Atlas.ti™ in consultation with the principal investigator. Each first coded a sample of interviews independently. The team then discussed the coding and agreed on broad coding categories. The team met regularly to discuss emerging constructs and agree on a detailed coding schema. We came to consensus on broad themes and selected illustrative quotations. Interpretation was pragmatic, focusing on the nature and consequences of participants' experiences, and their wishes and intentions with respect to information sharing. ResultsOf 27 respondents, all but three reported negative experiences with health care providers because of current or former SUD, ranging from judgmental to neglectful or inappropriate treatment, to disparagement and abuse. With few exceptions, they would not consider sharing their SUD history through an HIE without specific, revocable control over which individual providers could receive the information. ConclusionsRespondents' requirements are consistent with the legal requirements of 42 CFR Part 2. Implementing Part 2 compliant HIE will require overcoming substantial technical and procedural challenges.

Adjectives in the Summary Paragraph of the MSPE: Are They Telling Us Something?

Rationale and ObjectivesMany US medical schools do not provide a summative, comparative assessment of students (class rank), instead utilizing descriptive adjectives in the summary paragraph of the Medical Student Performance Evaluation (MSPE). The objective of this study was to determine whether those adjectives correlate with student performance. Materials and MethodsApplications from all US allopathic medical schools received by a single diagnostic radiology program in the 2023-24 cycle were reviewed. The final adjectives from schools that rank students were coded as positive, negative, or neutral. For students from non-ranking schools, descriptive adjectives from the MSPE summary paragraphs were extracted and categorized based on the final adjective coding schema along with a library of commonly used positive adjectives. The frequency of adjectives was correlated with applicant academic and demographic factors using multivariable logistic regression. ResultsApplications from 97% (147/151) of US allopathic medical schools were received. 60.5% (89/147) of schools rank their students with 27.9% (41/147) using a final adjective coded to performance tier. Of the 58 non-ranking schools, 56.9% (33/58) used descriptive adjectives in the MSPE’s summary paragraph. There was no association with academic performance metrics and either generally positive adjectives or coded descriptive adjectives. There was a greater association with positive descriptive adjectives for non-white applicants (p=0.011) and generally positive adjectives for higher ranked schools (p=0.004). ConclusionUndefined descriptive adjectives in the MSPE’s summary paragraph, when benchmarked to final adjectives, do not correlate with academic performance, and may instead be used for student advocacy by medical school deans.

Critical misconceptions and knowledge gaps regarding alcohol cessation and risk of relapse in alcohol-related liver disease patients: A qualitative mental models study

IntroductionDespite the mortality benefits of alcohol cessation and alcohol treatment, few patients with alcohol-related liver disease (ALD) get such treatment. To understand reasons for low treatment rates, we performed a qualitative mental models study to explore how ALD patients understand factors influencing alcohol cessation, relapse and their liver health. MethodsUsing a mental models framework, we interviewed experts in alcohol use disorder (AUD) and ALD to determine factors influencing alcohol cessation, risk of relapse and liver health. An expert influence diagram was constructed and used to develop a patient interview guide. We recruited participants with ALD enrolled in hepatology or transplant clinics at a single tertiary-care center. We conducted interviews either face-to-face or by phone, per participant preference. We transcribed all interviews verbatim and analyzed them using combined deductive coding schema based on both the interview guide and emergent coding. Results25 (10 women, 15 men) participants with a mean age of 57 years completed interviews. 68 % had decompensated cirrhosis. Major omissions included gender (as a factor in alcohol use or liver disease) and the influence of benzodiazepines/opioids on relapse. Misconceptions were common, in particular the idea that the absence of urges to drink meant participants were safe from relapse. Conceptual differences from the expert model emerged as well. Participants tended to view the self as primary and the only thing that could influence relapse in many cases, resulting in a linear mental model with few nodes influencing alcohol cessation. Participants' risky drinking signals (i.e., elevated liver enzymes) differed from known definitions of hazardous or high-risk drinking, which largely emphasize dose of alcohol consumed irrespective of consequences. Finally, participants sometimes viewed stopping on one's own as the primary means of stopping alcohol use, not recognizing the many other nodes in the influence diagram impacting ability to stop alcohol. ConclusionPatients with ALD had critical misconceptions, omissions, and conceptual reorganizations in their mental models of the ability to stop alcohol use. Attention to these differences may allow clinicians and researchers to craft more impactful interventions to improve rates of alcohol abstinence and AUD treatment engagement.

1 Efficacy of Digital and Non-Digital Compensatory Strategies in Supporting Prospective Memory Task Completion Among Community-Dwelling Older Adults

Objective:Compensatory strategies (CS) can assist in supporting everyday memory and functional independence. Digital compensatory strategies (e.g., calendar and notes apps) are being used more by older adults, but their effectiveness compared to paper-based strategies has been questioned due to their novelty and potential suitability. This study examined whether digital and non-digital strategies vary in quality and lead to accuracy differences in carrying out a set of real-world prospective memory (PM) tasks.Participants and Methods:Seventy community-dwelling older adults (Mage= 70.80, SD = 7.87) completed two testing sessions remotely from home via Zoom. Participants were presented four real-world PM tasks (packing for overnight trip, creating physical activity summary, paying bill by due date, and calling lab to leave message) and were encouraged to use their typical CS to support task completion. The type and quality of CS, as well as accuracy of PM task completion, were assessed using lab-developed coding schemas. Quality scores were on a 0-3 point scale per task step (maximum total score = 63), and accuracy scores were on a 0-4 point scale (maximum score = 16). Participants were differentiated into two groups: those who used at least one digital CS (40 participants) and those who did not use digital CS (30 participants). T-tests were examined for group differences in number of CS utilized, CS quality, and PM accuracy. Within each group, correlations between CS quality and PM accuracy were conducted. Group comparisons were also conducted for demographics, cognitive test performances, and questionnaires.Results:The technology group (M = 13.90, SD = 5.43) utilized significantly more strategies than the non-technology group (M = 9.50, SD = 4.12), t(68) = -3.71, p < .05, d = 0.91, and the technology group’s strategies (M = 42.48, SD = 10.47) were significantly higher quality than the non-technology groups (M = 33.80, SD = 13.02), t(68) = -3.09, p < .05, d = 0.73. However, the technology (M = 12.30, SD = 2.48) and non-technology (m = 11.87, SD = 3.16) groups completed the four PM tasks with equivalent accuracy, p > .05. Correlational analyses revealed that higher quality strategies were associated with better PM performance for both the technology (r = .67, p < .001) and the non-technology group (r = .71, p < .001). Although the technology group reported higher comfort with technology, both groups reported comparable levels of quality of life and functional independence and performed similarly on cognitive tests. The technology group trended towards being younger and having a higher level of global cognitive status (p = .07), but there were no group differences in education level or premorbid verbal ability.Conclusions:Digital compensatory strategies resulted in higher CS quality scores and more strategies used, but there was no significant difference in PM accuracy scores between digital and non-digital CS. Regardless of technology use, using high quality CS supported real-world PM performance. Interventions that focus on improving the quality of compensatory strategies being utilized by older adults may enhance everyday functioning.

CHARACTERIZING THE JOHNS HOPKINS INFLAMMATORY BOWEL DISEASE COHORT USING OMOP CDM

Abstract BACKGROUND Inflammatory Bowel Disease (IBD) is an increasingly prevalent condition that results in weight loss, bloody diarrhea, and poor quality of life. Traditional population-based research on patients with IBD has involved use of relatively shallow claims data that is deficient in precise demographics. IBD research using richly detailed electronic health record (EHR) data has been difficult due to the need for laborious manual chart review to extract information, but new methods and technology allow for rapid EHR data extraction. We present here the results of the extraction of IBD patient data from our EHR into the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). METHODS This study is an observational cohort study using patient health care data from our EHR extracted into the OMOP CDM. Transforming data into the standard CDM format allows for information from different databases and coding schema to be compared and aggregated. We used a de-identified dataset of all patients seen at Johns Hopkins Medicine since 2016. Our cohort of IBD, Crohn’s disease (CD), and Ulcerative Colitis (UC) patients were stratified by age, sex, race, weight, and pregnancy status. Within the cohorts, we obtained demographics, comorbidities, symptoms, labs, medications, and other data. We validated the extraction by comparison with EHR queries using Slicer/Dicer (SD). RESULTS There were 11,357 IBD patients including 6,512 CD patients and 4,224 UC patients. There were more female patients for both CD and UC (56.4% v 57.5%) and more white patients for both CD and UC (55.4% v 56.7%) compared to black (23.5% v 22.6%) and Asian patients (5.6% v 4.9%). CD and UC patients were treated with systemic steroids (49.1% v 51.5%), 5-ASA (24.9% v 47.2%) anti-TNF inhibitors (24.0% v 12%), IL12/23 inhibitors (8.4% v 2.7%), and JAK inhibitors (0.3% v 1.8%). Using SD queries, the percent differences were determined between the OMOP and EHR data, revealing a 0.54% difference in the number of CD patients and 10.36% difference in the number of UC patients (Table 1). CONCLUSION Using OMOP CDM to analyze clinical characteristics and outcomes for patients with IBD is a valuable method for obtaining de-identified patient data, reducing patient risk, and facilitating rapid creation of on-demand cohorts for multi-institutional research studies. This advantage is balanced by the lack of access to row-level data to validate cohorts. Local validation of data extraction through SD queries can allow for rapid creation of cohorts for big data research. The most significant differences between SD queries and OMOP CDM was in the calculation of prevalence of medications and race, suggesting that differing data extraction coding methods could result in queries that underestimate rates of treatment due to proprietary local coding schema.

Pediatric Septic Shock Care Pathways in General Emergency Departments: A Qualitative Study Targeting How to Really Make it Work.

Many academic pediatric emergency departments (PEDs) have successfully implemented pediatric septic shock care pathways. However, many general emergency departments (GEDs), who see the majority of pediatric ED visits, have not. This study aims to compare the workflow, resources, communication, and decision making across these 2 settings to inform the future implementation of a standardized care pathway for children with septic shock in the GED. We used the critical incident technique to conduct semistructured interviews with 24 ED physicians, nurses, and technicians at one PED and 2 GEDs regarding pediatric septic shock care. We performed a thematic analysis using the Framework Method to develop our coding schema through inductive and deductive analyses. We continued an iterative process of revising the schema until we reached consensus agreement and thematic saturation. We identified the following 6 themes: (1) functioning like a "well-oiled machine" may be key to high performance; (2) experiencing the sequence of care for children with sepsis as invariant and predictable may be essential to high-quality performance; (3) resilience and flexibility are characteristic of high levels of performance; (4) believing that "the buck stops here" may contribute to more accountability; (5) continuous system learning is essential; and (6) computerized clinical decision support may not be optimized to drive decision-making at the point of care. Commentary from GED and PED participants differed across the 6 themes, providing insight into the approach for standardized care pathway implementation in GEDs. Pediatric septic shock workflow, decision making, and system performance differ between the PED and GEDs. Implementation of a standardized care pathway in GEDs will require a tailored approach. Specific recommendations include (1) improving shared situation awareness; (2) simulation for knowledge, skill, and team-based training; and (3) promoting a culture of continuous learning.

Barriers to abortion provision in primary care in New England, 2019–2020: A qualitative study

ObjectiveTo assess barriers to and facilitators of abortion provision among abortion-trained primary care providers. Study DesignWe conducted 21 qualitative in-depth interviews with 20 abortion-trained family physicians and one internal medicine physician in five New England states. We dual-coded interviews, using a consensus method to agree upon final coding schema. Through iterative dialogue, using an inductive content analysis approach, we synthesized the themes and identified patterns within each domain of inquiry. ResultsThe most commonly reported barriers were a lack of organizational support, the Hyde Amendment, which prevents the use of federal funds for most abortion care, and the mifepristone Risk Evaluation and Mitigation Strategy, a federal regulation which prohibits routine mifepristone pharmacy dispensing. The logistical barriers created by these policies require cooperation from additional stakeholders, creating more opportunities for abortion stigma and moral opposition to arise. Other salient barriers included inter-specialty tension (particularly with obstetrician-gynecologists), perceived need for pre-abortion ultrasound, absence of a clinician support network, and lack of knowledge of existing resources for establishing abortion care in primary care. ConclusionsIncreased abortion provision in primary care is one of many necessary responses to the human rights crisis produced by the Dobbs decision. Eliminating the Hyde Amendment and ending federal regulations restricting pharmacy dispensing of mifepristone are key interventions to address barriers to primary care abortion provision. Building interspecialty partnerships between family medicine and OB/GYN and spreading awareness of the evidence-based ultrasound-as-needed protocol and other educational resources are also likely to increase primary care abortion access. ImplicationsBy exploring barriers to and facilitators of primary care abortion provision, this study outlines a targeted approach to support increased access to abortions. In states with legal abortion post-Roe, it is important that motivated and trained primary care providers can offer abortions, rather than referring patients to overburdened specialty clinics.

Poetic and Artistic Aspects of Digital Fabrication in Architecture

New production techniques and digital design tools allow new possibilities in architecture and digital fabrication laboratories provide an environment for these new opportunities. In addition to its potential in terms of science and technology, digital fabrication creates many opportunities for artistic aspects of architecture. Therefore we aimed to make a theoretical discussion and try to provide a new perspective for an evaluation of the phenomenon in the context of artistic and poetic aspects. From this perspective, to clarify the artistic aspects of architecture in the context of digital fabrication technologies and to understand how the subject is covered in the literature clearly, a comprehensive literature review has been made. Initially, the literature review was limited to the themes of digital fabrication and architecture to extract from out-of-context articles and 197 peer review journals written in the last 10 years were examined. Then, a pre-coding schema was prepared from two authors and extended after a detail literature review. The extended coding schema was grouped in terms of their semantic distance and these groups were used to make an assumption about papers. The software MAXQDA, which is commonly used in the social science, assist us to identify the semantic codes related to the research context without any omission. Articles were investigated with the keywords created after precoding. The remaining 51 articles on the field of Architecture were analysed through these codes. Our aim is not to prove if there is sufficient paper that discuss the artistic aspects of digital fabrication. However this methodology helps us to understand the focus of the papers and the tendencies as an approach in this context. In general, the subject of digital fabrication in architecture is studied more about materials, structures, processes, technology and how to use digital fabrication tools instead of why it was examined in the literature. From perspective of artistic dimension, the reviewed papers mainly emphasize ‘characteristic, identity, variety, style, concept, customization, subjective, subjectivity, formal, composition, tectonic, geometry, form’. On the other hand, ‘aesthetic, beauty, expression, art, stereotomy, craft, artifact, are less discusses codes. Words directly related to art and craft are not discussed in the articles and there is less discussion on the aesthetic values of digital fabrication. ‘Sense, experience, perception, intuition’ are also less discussed codes even if these are strong relationship with architectural context. Although not included in the academic literature, the issue of digital fabrication has begun to be discussed in the context of experience, through art installations in 1:1 scale produced by digital fabrication tools. In a nutshell, the issue of art is at least as valuable as the most frequently asked question of how in digital fabrication, and this aspect should be given more place in scientific research.

Media features and communication control in the digitalized workplace: a study about regulating negative emotional communication

PurposeOne challenge facing the digitalized workplace is communication control, especially emotion regulation in which individuals try to manage their emotional experiences and/or expressions during organizational communication. Extant research largely focused on the facilitating role of a few media features (e.g. fewer symbol sets). This study seeks to provide a deeper understanding of media features that individuals, as receivers of negative emotions expressed by communication partners, could leverage to support regulating negative emotional communication in the workplace.Design/methodology/approachThis study used qualitative research methods to identify media features that support regulating negative emotional communication at work. Data were collected using interviews and was analyzed using directed content analysis in which media features discussed in media synchronicity theory (MST) were used as the initial coding schema but the researcher was open to media features that do not fit with MST.FindingsIn addition to media features (and capabilities) discussed in MST, this study identified five additional media features (i.e. message broadcasting, message blocking, receiving specification, recipient specification and compartmentalization) and two underlying media capabilities (i.e. transmission control capability and participant control capability) that may support regulating negative emotional communication. Two major mechanisms (i.e. reducing or eliminating emotion regulation workload, and providing prerequisites or removing obstacles for emotion regulation) via which media features support emotion regulation were also identified.Originality/valueThis paper provides a more comprehensive understanding regarding communication media features that may support emotion regulation in particular and communication control in general. Findings of this study contribute to several literatures and may also transfer to other similar contexts.

344 Qualitative Description of Synchronous Online Discussions During Weekly Academic Conference

COVID-19 dramatically changed weekly academic conferences with virtual presentations replacing in-person didactics. Through group chat functions, modern communication platforms provide the opportunity for synchronous online discussions to occur in parallel with didactic presentations. We sought to qualitatively characterize the content, nature, and educational uses of synchronous online discussions occurring during weekly academic conferences and to assess the attitudes of lecturers and audience members towards these discussions. Transcripts of synchronous online discussions occurring from 7/1/20 to 12/31/20 were qualitatively analyzed using a grounded theory approach. Initial themes were identified by the primary author. Following a preliminary coding by the study authors, the themes were iteratively refined to arrive at a final coding strategy. Each month’s transcripts were coded by 2 study authors. When there was disagreement between coders, the primary author made a final coding determination. Following the study period, a survey distributed to residents and faculty assessed attitudes towards the synchronous online discussions. The qualitative analysis of the transcripts identified 2352 coded messages. The final coding schema can be seen in Figure 1. Of 1720 identified content codes, the most commonly identified themes were cultural communications (40.8%) and knowledge sharing (39.0%). Within the broader theme of knowledge sharing, participants were most likely to share individual practice experience (366/671 codes). Statements with uncited data/evidence (113 codes) occurred in similar frequency to sharing of academic resources (137 codes). Questions directed towards other members of the audience (48.8% of questions) were only slightly less common than questions directed to the lecturer (51.2% of questions). There were 56 respondents to the survey (30 residents, 25 faculty, 1 fellow). Of the 44 respondents that had presented didactics, 54.5% (24/44) identified that it was challenging to keep up with the synchronous online discussion. From the perspective of the audience, 82.1% (46/56) felt it was easy to keep up with the discussion. Presenters of didactics felt identifying a member of the audience as a surrogate was the easiest means to keep up with the discussion (75%, 33/44 presenters). Audience members agreed that they were much more likely to ask a question in a synchronous online discussion as opposed to speaking out loud (71.4%, 40/56). Weekly academic conferences are a critical component of residency education, enabling not only the acquisition of knowledge but also the social sharing of knowledge/experiences developing of robust communities of practice. Our qualitative analysis found that cultural communication occurred with near equal frequency to knowledge sharing and that sharing of individual practice experiences was more common than sharing of academic resources. These synchronous online discussions may make it more likely for audience members to ask questions of each other or the lecturer but keeping up with the discussion was challenging for lecturers.

Inaccuracies and exaggerations (Health Coverage)

Inaccuracies and exaggerations (Health Coverage)

\u201cFeeling clean\u201d: stigma and intravaginal practices among female entertainment workers in Cambodia

BackgroundIntravaginal practices (IVPs), methods used by women most often to manage vaginal hygiene and address perceived disruptions to vaginal health, may increase the risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This qualitative study explores the social, professional, and peer context surrounding IVPs, the experiences of self-cleaning or getting cleaned from a health professional, and the perceived impacts of IVPs among female entertainment workers (FEWs) in Cambodia.MethodsIn 2017, we conducted 27 focus group discussions from four provinces, and 16 follow-up semi-structured in-depth interviews with purposively selected participants in two provinces. Data collection occurred over three weeks, with concurrent data transcription and translation. The data from the transcripts were analyzed using Dedoose, an online, open-access qualitative analysis software. Two researchers independently labeled sections of transcripts associated with broader categories and subcategories based on the initial content analysis matrix and created codes. This process continued iteratively until a final coding schema and conceptual model was created.ResultsWe found that IVPs are widely practiced among FEWs in Cambodia and are associated with internalized and enacted stigma. Stigma was an overarching theme that impacted the sub-themes of (1) messages about cleaning, (2) the cleaning process, and (3) the impact of cleaning. Experiences of enacted stigma and internalized stigma permeated conversations about IVP, including feeling pressured by peers to keep themselves clean, practicing internal cleaning after transactional sex, and being called dirty by health providers.ConclusionsFEWs who practice IVP talk about it in the context of their lived experiences stigma and discrimination. Highly stigmatized practices such as IVP among FEWs may benefit from a harm reduction approach that emphasizes positive changes without judgment, coercion, or discrimination.

Chessboard-Like High-Frequency Patterns for 3D Measurement of Reflective Surface

Surface reflections severely degrade the performance of the structured-light 3D measurement. In this article, we introduce a novel structured-light 3D measurement technique that works in the presence of reflective highlights. The focus of this article is on designing chessboard-like coding schema and crossover-based decoding schemes. First, we design chessboard-like fringe patterns that are resistant to reflective highlights by using simple logical operations. Compared with conventional coding schemes that inevitably have low-frequency patterns, the chessboard-like coding schemes use all-high-frequency patterns to provide a better highlights-suppression effect. Second, we propose an inverse-pattern method to extract crossover positions for decoding. The chessboard-like patterns have abundant crossover information. The crossover information is more localizable and better preserved than image intensity, which makes the decoding strategy more robust. Moreover, both positive and negative patterns are used to precisely localize the crossover positions. The proposed method can be readily incorporated into existing binary structured-light measurement techniques without significant overhead in terms of capture time or hardware. Extensive experiments are shown to demonstrate the high performance of the proposed method.

Consolidating core entrepreneurial competences: toward a meta-competence framework

PurposeEmerging digital ventures and related breakthrough innovations result in new challenges for the development of entrepreneurial competences and demand new perspectives for entrepreneurship research. In this context, policy-makers and organizations are increasingly interested in fostering entrepreneurial competences to improve the success of policies and venture capital investments. This paper aims at identifying the core relevant entrepreneurial competences, mapping the current literature and the main clusters and going beyond toward a meta-competence framework.Design/methodology/approachThe research approach is a literature review, combining bibliometric, network and content analysis. The sampling process was conducted in the Scopus and Web of Science databases. The bibliometrics and content analysis were performed with a computer aid approach applying VosViewer1.6, Ucinet and NetDraw 2.139. The content analysis approach was performed considering a detailed coding schema developed. Finally, toward the meta-competences framework, the study applied quantitative analysis on the coding schema, particularly cross-tabulation, core-periphery and network analysis.FindingsThe results show the state of the art concerning entrepreneurial competences. The research identified a list of 98 entrepreneurial competences. Finally, the study proposes a meta-competence framework and clusters the 33 core entrepreneurial competences previously identified.Originality/valueThe proposed conceptual framework exploring meta-entrepreneurial competences offers an original contribution with implications for theory and practice. The research contributes to broadening the understanding of the entrepreneurial competences, helping on the creation, design, development and improvement of entrepreneurship educational initiatives, which are important to entrepreneurs' educators. The proposed framework contributes by providing relevant knowledge for the policy-makers' strategy formulation processes. As implications for the practice, the proposed framework can allow better assessment process for incubators and accelerators, besides more robust ventures considering learning trails based on meta-competences frameworks.

Haptic Perception in Extreme Obesity: qEEG Study Focused on Predictive Coding and Body Schema.

Haptic perception (HP) is a perceptual modality requiring manual exploration to elaborate the physical characteristics of external stimuli through multisensory integrative cortical pathways. Cortical areas exploit processes of predictive coding that collect sensorial inputs to build and update internal perceptual models. Modifications to the internal representation of the body have been associated with eating disorders. In the light of this, obese subjects were selected as a valid experimental model to explore predictive coding in haptic perception. To this purpose, we performed electroencephalographic (EEG) continuous recordings during a haptic task in normally weighted versus obese subjects. EEG power spectra were analyzed in different time intervals. The quality of haptic performance in the obese group was poorer than in control subjects, though exploration times were similar. Spectral analysis showed a significant decrease in theta, alpha and beta frequencies in the right temporo-parietal areas of obese group, whereas gamma bands significantly increased in the left frontal areas. These results suggest that severe obesity could be characterized by an impairment in haptic performances and an altered activation of multisensory integrative cortical areas. These are involved in functional coding of external stimuli, which could interfere with the ability to process a predicted condition.

Abstract 13290: Variation in Coding for Major Cardiac Diagnoses and Procedures in Cardiac Research Using the National Inpatient Sample

Introduction: Code selection is crucial to the accuracy and reproducibility of studies using administrative data, however a comprehensive assessment of coding trends for major cardiac diagnoses and procedures is lacking. Hypothesis: Given the absence of consensus guidelines for administrative code utilization, heterogeneity in code selection for major cardiovascular diagnoses and procedures will be uncovered. Methods: We queried PubMed, CINAHL, Scopus, Medline, and the HCUP Publication Search from inception through March 1st, 2018 for all publications using the National Inpatient Sample (NIS), featuring a primary focus on the heart. ICD-9-CM codes reported for acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) were collected and analyzed for accuracy and consistency. All studies were also evaluated for adherence to required methodological practices as per previously reported methods. Results: Of 2637 articles identified, 445 were included in the observational analysis. 399 articles (84%) did not adhere to one or more research practices required by the AHRQ, however overall adherence was superior for publications in higher impact journals ( P = 0.0019). Heterogeneity in code utilization was observed for each diagnosis and procedure assessed, with up to 37 unique case definitions reported for HF and PCI. Nonspecific codes were included in 39 (8.8%) studies, and coding heterogeneity increased throughout the study period ( P trend < 0.001 for all cardiac diagnoses and procedures). Coding schema endorsed by national-level clinical guidance documents were infrequently represented, reported in only 8.9% and 1.3% of AMI and HF articles, respectively. Upon reintroduction into the NIS for the period of 2008 to 2012, selected unique case definitions for AMI were found to yield significantly different estimates of AMI incidence. Conclusions: Substantial heterogeneity in code selection exists for major cardiac diagnoses and procedures, with important implications for the accuracy and generalizability of analyses using the NIS. Further efforts are required to establish consensus protocols to ensure consistency in code utilization.

Participatory design for ontologies: a case study of an open science ontology for qualitative coding schemas

PurposeThe open science movement calls for transparent and retraceable research processes. While infrastructures to support these practices in qualitative research are lacking, the design needs to consider different approaches and workflows. The paper bases on the definition of ontologies as shared conceptualizations of knowledge (Borst, 1999). The authors argue that participatory design is a good way to create these shared conceptualizations by giving domain experts and future users a voice in the design process via interviews, workshops and observations.Design/methodology/approachThis paper presents a novel approach for creating ontologies in the field of open science using participatory design. As a case study the creation of an ontology for qualitative coding schemas is presented. Coding schemas are an important result of qualitative research, and reuse can yield great potential for open science making qualitative research more transparent, enhance sharing of coding schemas and teaching of qualitative methods. The participatory design process consisted of three parts: a requirement analysis using interviews and an observation, a design phase accompanied by interviews and an evaluation phase based on user tests as well as interviews.FindingsThe research showed several positive outcomes due to participatory design: higher commitment of users, mutual learning, high quality feedback and better quality of the ontology. However, there are two obstacles in this approach: First, contradictive answers by the interviewees, which needs to be balanced; second, this approach takes more time due to interview planning and analysis.Practical implicationsThe implication of the paper is in the long run to decentralize the design of open science infrastructures and to involve parties affected on several levels.Originality/valueIn ontology design, several methods exist by using user-centered design or participatory design doing workshops. In this paper, the authors outline the potentials for participatory design using mainly interviews in creating an ontology for open science. The authors focus on close contact to researchers in order to build the ontology upon the expert's knowledge.

JA:2021-25. Increasing Efficiency and Reliability of Agricultural Injury and Fatality Coding with Standard Operating Procedures: Lessons Learned from AgInjuryNews.org

ABSTRACT Purpose: News media reports of agricultural injuries can be useful to better inform safety and health stakeholders and prevention efforts. These data are particularly useful for youth incidents, since the National Institute of Occupational Safety and Health discontinued their survey-based agriculture surveillance program in 2015, leaving a gap in reliable, consistent data on both youth and adult agricultural injuries and fatalities. In this study we describe how coding data derived from news reports, with a detailed Standard Operating Procedure (SOP) and refined inclusion/exclusion criteria, can lead to more efficient workflows to capture and code agricultural injury data. Methods: To capture quality data and improve inter-rater reliability we employ a multi-coder process. The first coder enters primary data into the Case Report Form (CRF), and a second coder reviews these data points for agreement. While reviewing for agreement, the second coder diverges into two other occupational/agricultural injury coding schemas (Occupational Illness and Injury Classification System [OIICS] and Farm and Agricultural Injury Classification [FAIC]) and employs an additional multi-coder and interrater reliability process, adding to the multifaceted workflow and detailed data output. This secondary coding schema and reliability ratings are discussed in a separate manuscript. Any discrepancies from the initial review are then discussed and settled between first and second coders. All CRFs are sent to another team member who reviews >10% and publishes the reports for public use on AgInjuryNews.org. International cases endure a similar process, but without OIICS or FAIC coding. In partnership with the Canadian Agricultural Safety Association, our team began Canadian injury report capture and coding in the fall of 2019. Findings: We developed a structured and detailed SOP for coding agricultural data obtained from news reports. Use of the SOP and refined inclusion/exclusion criteria were crucial when: 1) onboarding additional coders; 2) employing multiple coders; 3) refining search terms in data collection; 4) coding of emerging technologies and trends; and 5) improving the efficiency and quality of the data. Translation: Coders’ ability to reference a thoroughly vetted SOP and inclusion/exclusion criteria may lead to improved data coding for agricultural injuries and fatalities.

Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment.

BackgroundSocial media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media.ObjectiveThe objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers.MethodsWe conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site.ResultsA novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces.ConclusionsGiven the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange.

What Words Convey: The Potential for Patient Narratives to Inform Quality Improvement.

For the past 25 years, health care providers and health system administrators have sought to improve care by surveying patients about their experiences. More recently, policymakers have acted to promote this learning by deploying financial incentives tied to survey scores. This article explores the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement. Narratives were collected from 348 patients recruited from a nationally representative Internet panel. Drawing from the literature on health services innovation, we developed a two-part coding schema that categorized narrative content in terms of (a) the aspects of care being described, and (b) the actionability of this information for clinicians, quality improvement staff, and health system administrators. Narratives were coded using this schema, with high levels of reliability among the coders. The scope of outpatient narratives divides evenly among aspects of care currently measured by patient experience surveys (35% of content), aspects related to measured domains but not captured by existing survey questions (31%), and aspects of care that are omitted from surveys entirely (34%). Overall, the narrative data focused heavily on relational aspects of care (43%), elaborating on this aspect of experience well beyond what is captured with communication-related questions on existing surveys. Three-quarters of elicited narratives had some actionable content, and almost a third contained three or more separate actionable elements. In a health policy environment that incentivizes attention to patient experience, rigorously elicited narratives hold substantial promise for improving quality in general and patients' experiences with care in particular. They do so in two ways: by making concrete what went wrong or right in domains covered by existing surveys, and by expanding our view of what aspects of care matter to patients as articulated in their own words and thus how care can be made more patient-centered. Most narratives convey experiences that are potentially actionable by those committed to improving health care quality in outpatient settings.