Category Archives: Uncategorized

The PREDIMED score

fruitbowl2byhotblack

In their article on Mediterranean dietary indices, D’Alessandro and de Pergola’s descriptions include PREDIMED. I was just looking at this and it is very easy to understand and apply. Taking this as an example of a dietary index, it can be seen that there is a focus specifically on the food components of the diet and not with associated lifestyle factors. This wider context of lifestyle factors has been considered in the modern Italian Mediterranean Food Pyramid and this distinction is relevant to any critical appraisal of research studies. The authors of the above study also emphasise the importance of characterising the original diets adopted at recruitment into the seven countries study many decades ago.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

 

Mapping ICD 9 (or 10) to SNOMED CT®

Dr Lee Min Lau gives a succinct explanation of some considerations inherent in mapping ICD9 (or 10) coding to SNOMED CT in electronic health records.

Appendix A – Other Posts in the Series on Health Information Exchanges

Arizona Statewide Health Information Exchange

A History of The Health Information Exchange in Pennsylvania

The Arkansas Health Information Exchange – SHARE

The California Health Information Exchange – Cal Index

Health Information Exchanges

Health Information Exchanges and Chronic Conditions

HIPPA and Health Information Exchanges

Creating a Health Information Exchange in Arizona

Over 1 Million Relationships: SNOMED CT ®

Standardisation of Health Information Technology in New Zealand

Why Do We Need Electronic Record Systems to Talk to Each Other

Appendix B – Definition of Health Information Exchange

This is the definition of the Health Information Exchange that I use (Hersh et al, 2015)

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations‘.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

 

 

Measuring Adherence to the Mediterranean Diet

fruitbowl2byhotblack

D’Alessandro and de Pergalo have published an article on dietary indexes for the Mediterranean diet.

They are primarily interested in cardiovascular disease research.

I’ve looked at this article to learn a little more about how adherence to the Mediterranean diet is measured. There is a lot of research about the Mediterranean diet and possible health benefits.

A core aspect of these studies is how adherence to the diet is measured. Researchers need to generate a quantitative measure of dietary adherence in order to correlate this with health measures (there are very valuable insights that can also be gained from qualitative studies).

The paper is a comprehensive review of the literature and along the way, the authors propose how different food groups could be treated in terms of indexes in future studies.

What I found really interesting was how the different indexes vary subtly and even individual measures generate variations which are then further refined. Understanding these indexes is key to understanding what researchers are measuring and the ecological validity.

This paper is a good starting point for those interested in the literature around the Mediterranean diet

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

Over 1 Million Relationships: SNOMED CT®

Dr Kent Spackman, former chief terminologist for IHTSDO gives a presentation on SNOMED CT. The talk is divided into several segments (presumably for technical reasons) and I think part of the middle section may be missing. The videos above are helpful in gaining insights into the sheer scale of SNOMED CT as a coding system.

Dr Spackman aims to provide an overview without going into too much technical detail. He explains clinical identifiers, concepts, classes and instances, item and partition identifiers as well as a check digits. Dr Spackman explains the subtle semantics which reflect programming terminology and concepts.

There are 63,564 disorder concepts. 27948 organisms and 25,627 body structures as well 139,348 defining relationships using anatomy. There are over 1 million relationships that are possible within the SNOMED CT coding system. He also talks about the specialised rules that define the relationships.

Dr Spackman also talks about information models. For instance free text is one of the simplest information models but makes it difficult for analysis.

The presentation gives an insight into the complexity and flexibility of SNOMED CT.

Appendix A – Other Posts in the Series on Health Information Exchanges

Arizona Statewide Health Information Exchange

A History of The Health Information Exchange in Pennsylvania

The Arkansas Health Information Exchange – SHARE

The California Health Information Exchange – Cal Index

Health Information Exchanges

Health Information Exchanges and Chronic Conditions

HIPPA and Health Information Exchanges

Creating a Health Information Exchange in Arizona

Standardisation of Health Information Technology in New Zealand

Why Do We Need Electronic Record Systems to Talk to Each Other

Appendix B – Definition of Health Information Exchange

This is the definition of the Health Information Exchange that I use (Hersh et al, 2015)

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations‘.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

 

SNOMED CT

I’ve been looking at the subject of health information exchanges in this series. The exchange of information between different health information systems is facilitated by the development of standards. One international standard that has been developed is SNOMED CT. This NHS Digital video is a brief introduction to SNOMED CT which is scheduled to replace READ in primary care by April 2018.

Appendix A – Other Posts in the Series on Health Information Exchanges

Arizona Statewide Health Information Exchange

A History of The Health Information Exchange in Pennsylvania

The Arkansas Health Information Exchange – SHARE

The California Health Information Exchange – Cal Index

Health Information Exchanges

Health Information Exchanges and Chronic Conditions

HIPPA and Health Information Exchanges

Creating a Health Information Exchange in Arizona

Standardisation of Health Information Technology in New Zealand

Why Do We Need Electronic Record Systems to Talk to Each Other

Appendix B – Definition of Health Information Exchange

This is the definition of the Health Information Exchange that I use (Hersh et al, 2015)

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations‘.

 

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

 

 

When is a Research Question Settled?

magnifyingglass.1

I was looking at the Corfu paper by Pitsavos and colleagues when it got me thinking about the bigger question of research goals. Research is about answering questions, learning more about the world and how things work. In healthcare research we expect research to produce an understanding of health and illness. We should also be able to apply this research to help improve lives.

So a very nice question to ask is ‘when is a research question settled?’. When is it unnecessary to do any more research in this area? Take the paper above for instance. The researchers looked at some of the variables related to coronary heart disease risk. The age of the participant at entry to the study was associated with a hazards ratio of 1.1 with a p value of less than 0.001 and a 95% confidence interval of 1.06-1.14. The hazards ratio for smoking was 1.79 (95% CI 1.15-2.77) with a p-value of 0.01. The hazards ratio for BMI was 1.05 with a p-value of 0.1 however. Since the arbitrary cut-off limit for significance is usually set at 5%, this would not be significant. Additionally the 95% confidence interval is 0.99-1.10 confirming that this association is less than straightforward.

For each of the questions above, we are talking about a population. Even when we talk very robustly about the results at a population level, we can then move to the individual level. Population level results become difficult to talk about at an individual level as there are many variables that predict outcome and which can vary considerably between people. So if we have extreme confidence in a research question at a population level, we can always move to a discussion of the individual to refine the questions we ask. This is one aspect of personalised medicine.

However my conclusion from reflecting on the paper and the question was that there must be a hierarchy of answers to research questions. When Kuhn talks about the end of scientific inquiry in one research area, this becomes a tool for other areas of science. For instance, we know that the first element of the periodic table is hydrogen. It doesn’t matter how much is invested into building research studies to investigate the identity of the first element of the periodic table – it’s already been done. The studies wouldn’t produce any new answers to that particular question.

So some questions have been answered. Do they pass into a realm of what we would describe as facts, axioms or theorems?

What prevents us from reaching the answers to other questions?

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

Characteristics of the Corfu Older Adult Cohort from the Seven Countries Study (updated)

fruitbowl2byhotblack

Pitsavos and colleagues published a paper in 2003 on the Seven Countries Study. They followed up a cohort from Corfu, 40 years after the original recruitment into the study. The researchers were primarily interested in coronary heart disease outcomes but what I found more interesting were the characteristics of the sample.

Firstly by selecting the characteristics, there is a risk of selection bias. Secondly a study would have a primary outcome and a risk that positive findings for secondary outcomes may be due to chance. The more of these secondary outcomes you look at, the more likely you are going to find false positives.

That aside, there were 67 men surviving 40 years after recruitment into the study (529 men were recruited into the study originally). Half of the original sample were farmers. The average age was 85 (rounding up). 94% of the sample lived in their own home. 58% described themselves as optimistic. 7% were described as working professionally. 87% were physically active and physical activity ranged from 5-7 times per week. 90% had an afternoon siesta. 75% drank wine and the average was 14 x 100ml glasses per week. 21% had a Geriatric Depression Scale score > 5 (a threshold for caseness but which does not substitute for clinical assessment – so a score over 5 does not necessarily imply depression). 85% ate vegetables every day. 83% ate fruits every day. 87% ate bread every day. 95% consumed olive oil every day. 5% ate meat every day. 23% ate eggs every day. 21% consumed dairy products every day.

We can’t really answer any questions by citing this data. The authors have answered questions about coronary heart disease using established methodology.

Instead we can paint a picture of one cohort that participated in the original seven countries study.

Appendix – Full Citation

Pitsavos C, Panagiotakos DB, Menotti A, Chrysohoou C, Skoumas J, Stefanadis C,
Dontas A, Toutouzas P. Prev Cardiol. 2003 Summer;6(3):155-60. Forty-year follow-up of coronary heart disease mortality and its predictors: the Corfu cohort of the seven countries study.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.