Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders

Purpose Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. Methods A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: (1) UE symptoms, (2) UE musculoskeletal disorders (MSD), (3) carpal tunnel syndrome (CTS), and (4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. Results All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. Conclusions Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work.     

Surveillance case definitions for work related upper limb pain syndromes

OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. RESULTS: Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diffuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. CONCLUSIONS: There was enough consensus between several health professionals from different disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management.

 

     

Key features of bone and joint infections following the implementation of reference centers in France

Objectives

French reference centers for bone and joint infections (BJI) were implemented from 2009 onwards to improve the management of complex BJIs. This study compared BJI burden before and after the implementation of these reference centers.

A common, symptom-based case definition for gastroenteritis

National studies determining the burden of gastroenteritis have defined gastroenteritis by its clinical picture, using symptoms to classify cases and non-cases. The use of different case definitions has complicated inter-country comparisons. We selected four case definitions from the literature, applied these to population data from Australia, Canada, Ireland, Malta and the United States, and evaluated how the epidemiology of illness varied. Based on the results, we developed a standard case definition. The choice of case definition impacted on the observed incidence of gastroenteritis, with a 1.5-2.1 times difference between definitions in a given country. The proportion of cases with bloody diarrhoea, fever, and the proportion who sought medical care and submitted a stool sample also varied. The mean age of cases varied by <5 years under the four definitions. To ensure comparability of results between studies, we recommend a standard symptom-based case definition, and minimum set of results to be reported.     

Case Definitions for Acute Myocardial Infarction in Administrative Databases and Their Impact on In‐Hospital Mortality Rates

Objective

To identify validated ICD-9-CM/ICD-10 coded case definitions for acute myocardial infarction (AMI).

Data Sources

Ovid Medline (1950–2010) was searched to identify studies that validated acute myocardial infarction (AMI) case definitions. Hospital discharge abstract data and chart data were linked to validate identified AMI definitions.

Study Design

Systematic literature review, chart review, and administrative data analysis.

Data Collection/Extraction Methods

Data on sensitivity/specificity/positive and negative predictive values (PPV and NPV) were extracted from previous studies to identify validated case definitions for AMI. These case definitions were validated in administrative data through chart review and applied to hospital discharge data to assess in-hospital mortality.

Principal Findings

Of the eight ICD-9-CM definitions validated in the literature, use of ICD-9-CM code 410 to define AMI had the highest sensitivity (94 percent) and specificity (99 percent). In our data, ICD-9-CM/ICD-10 codes 410/I21-I22 in all available coding fields had high sensitivity (83.3 percent/82.8 percent) and PPV (82.8 percent/82.2 percent). The in-hospital mortality among AMI patients identified using this case definition was 7.6 percent in ICD-9-CM data and 6.6 percent in ICD-10 data.

Conclusions

We recommend that ICD-9-CM 410 or ICD-10 I21-I22 in the primary diagnosis coding field should be used to define AMI. The use of a consistent validated case definition would improve comparability across studies     

What Is Real-World Data? A Review of Definitions Based on Literature and Stakeholder Interviews

Background

Despite increasing recognition of the value of real-world data (RWD), consensus on the definition of RWD is lacking.

Falldefinitionen für die Surveillance meldepflichtiger Infektionskrankheiten in Deutschland,Ausgabe 2015

Case definitions ensure standardised criteria for the surveillance of infectious diseases in Germany. Since its last revision in 2007, an update of the complete case definition edition became necessary due to new scientific insights, changes in legislature, terminology and classification systems. At the same time, the case definition should be further standardised and work at local public health authorities should be simplified. The department for infectious disease epidemiology at the Robert Koch Institute (RKI) coordinated the revision of the case definitions. During several feedback sessions, internal RKI experts and external experts from different levels of the German public health system, as well as from medical associations and laboratories, were involved in the revision process. The new edition and an annotated version are published on the RKI website (www.rki.de/falldefinitionen). The new case definitions will become effective on 1st January 2015. The most important changes are summarised in this article.     

Defining social support in context: a necessary step in improving research, intervention, and practice

A substantial body of work on the concept of social support has resulted in many definitions, but none have been accepted as definitive. The lack of consensus about the definition of social support has resulted in a lack of consistency and comparability among studies. More important, the validity of any study attempting to measure or influence social support is undermined by the use of generic definitions, which lack contextual sensitivity. In this article concept analysis is used to evaluate definitions of social support to ascertain their utility for research. The authors argue that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful. They also assert that the development of a contextualized definition of social support requires qualitative methods to explore the meaning of social support with groups of people for whom intervention research is ultimately intended.     

Methodological issues in diarrhoeal diseases epidemiology: definition of diarrhoeal episodes.

A review of the diarrhoeal disease literature reveals considerable variability in the definition of diarrhoeal episodes. The use of various definitions of diarrhoea and episodes leads to misclassification, affects the estimates of the disease burden in communities and reduces comparability of the findings from different studies. This study is an attempt to validate the definition of diarrhoeal episodes using prospectively collected community-based surveillance data. In comparative validation analyses, three or more loose stools or any number of loose stools containing blood in a 24-hour period seemed to be the best definition of diarrhoea. Three intervening diarrhoea-free days seemed to be the optimum to define a new episode. The implications of using differing definitions and the importance of using a validated definition are discussed.