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94 Digitized Archimedes Spiral Drawing in the NKI-Rockland Sample
- Stan Colcombe, Anna MacKay-Brandt, Ava Waters, Sarah Abdelaziz, Nora Liu
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 769-770
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Objective:
Digital cognitive assessments (DCAs) provide insight into cognition and behavior that remains inaccessible through standard assessment approaches. However, the availability of DCAs and the requisite toolkits to extract and analyze meaningful features from these datasets are largely constrained to technical specialists or through fee-for-service commercial entities. The NKI- Rockland Sample provides a large- scale lifespan data sample featuring DCAs, and also openly shares its DCA tasks through the open-source MindLogger platform along with pipelines for feature extraction and analyses. Here we present normative performance from a digital version of Archimedes Spiral Drawing.
Participants and Methods:NKI-RS2 participants were largely drawn from the existing NKI-RS participant pool (n= 1,500), aged 885. The NKI-RS2 is in year 1 of data collection; here, we report on a subset of participants (n= 9) who performed a digitized version of the Archimedes Spiral Drawing task. This graphomotor task with well-established research and clinical utility in movement disordered populations was adapted for use for off-the-shelf tablet devices. The NKI-RS2 implements these tasks on an Apple iPad Pro2, sampling participant drawing at 120Hz, and featuring pixel- and millisecond- level resolution for all tasks. On the Spiral Drawing and Recall Tests participants traced five Archimedes spirals from the center outward through four windings presented on the iPad. They were then asked to replicate the spiral freehand three times. From these spiral drawings, we extracted time to completion, distance covered, speed/ speed variability, rotational smoothness, number of crossings, mean absolute error, bias, and goodness of fit to the ideal Archimedes spiral.
Results:Comparing the tracing and recall conditions, participants showed significantly faster drawing speed (t[8]=5.32, p< .001), more variable drawing speed (t[8]=5.93, p< .001), reduced goodness of fit to the template t[8]=4.99, p< .002, and reduced rotational smoothness (t[8]=7.43, p< .0003) in the recall conditions. Collapsing across conditions, age predicted more variable drawing speed: t[8]= 2.77 p< .019, greater tracing error (t[8] = 2.69, p< .0227), and reduced rotational smoothness (t[8] = 2.67, p< .024). Between conditions, age predicts a greater increase in drawing speed variability (t[8] = 9.76, p< .0006).
Conclusions:Using the open source MindLogger platform and off-the-shelf digital tablets, we were able to replicate classic paper and pen neuropsychological tests. By adapting these tasks to DCA, we were able to extract meaningful features that are not otherwise accessible (drawing speed, variability, etc.), or that would require additional hardware solutions (e.g., dwell time). By making these tasks and their processing pipelines available, the NKI-RS2 can facilitate the democratization of DCA and DCA analysis to a broader range of researchers and clinicians.
Novel Method to Evaluate Diagnostic Shifting After a Pediatric Antibiotic Stewardship Intervention
- Nora Fino, Benjamin Haaland, Karl Madaras-Kelly, Katherine Fleming-Dutra, Adam Hersh, Emily Thorell, Diane Liu, Matthew Samore
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s332-s333
- Print publication:
- October 2020
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Background: Audit-and-feedback interventions track clinician practice patterns for a targeted practice behavior. Audit and feedback of antibiotic prescribing data for acute respiratory infections (ARI) is an effective stewardship strategy that relies on administrative coding to identify eligible visits for audit. Diagnostic shifting is the misclassification of a patient’s diagnosis in response to audit and feedback and is a potential unintended consequence of audit and feedback. Objective: To develop a method to identify patterns consistent with diagnostic shifting including both positive shifting (improved diagnosis and documentation) and negative shifting (intentionally altering documentation of diagnosis to justify antibiotic prescribing), after implementation of an audit-and-feedback intervention to improve ARI management. Methods: We evaluated the intervention effect on diagnostic shifting within 12 University of Utah pediatric clinics (293 providers). Data included 66,827 ARI diagnoses: pneumonia, sinusitis, bronchitis, pharyngitis, upper respiratory infection (URI), acute otitis media (AOM), or serous otitis with effusion (OME). To determine whether rates of ARI diagnoses changed after the intervention, we developed logistic generalized estimating equation (GEE) models with robust sandwich standard error estimates to account for clinic-wise clustering. Outcomes included the change in each ARI diagnosis relative to the competing 6 diagnoses included in audit-and-feedback reports before and after intervention implementation. Models tested for a change in outcomes after the intervention (ie, diagnostic shift) after adjustment for month of diagnosis. For each diagnosis, we estimated the population attributable fraction (PAF) for antibiotic prescriptions due to combined shifts in diagnostic frequencies and prescription rates for each diagnosis. The PAF is the estimated fraction of antibiotic prescriptions that would have changed under a population-level intervention. Results: In month-adjusted analyses, diagnoses of pneumonia and OME decreased after the intervention: odds ratio (OR), 0.46 (95% CI, 0.31–0.68) and OR, 0.81 (95% CI, 0.67–0.99), respectively. In addition, URI diagnoses increased: OR, 1.05 (95% CI 1.00, 1.11). We did not detect changes in the diagnosis rates of sinusitis, AOM, bronchitis, and pharyngitis post intervention. The intervention effect on the PAF for antibiotics prescriptions was consistently positive but relatively small in magnitude. PAF was highest for URIs (PAF, 8.87%), followed by AOM (PAF, 3.56%) and sinusitis (PAF, 2.76%), and was lowest for pneumonia and bronchitis (PAF, 0.41% for both). Conclusions: Our analysis found minimal evidence overall of diagnostic shifting after a stewardship intervention using audit and feedback in these pediatric clinics. Small changes in diagnostic coding may reflect more appropriate diagnosis and coding, a positive effect of audit and feedback, rather than intentional negative diagnostic shift.
Funding: None
Disclosures: None
Association of Receipt of Antibiotics with Patient Satisfaction for Caregivers of Children Presenting to Urgent-Care Settings
- Diane Liu, NORA FINO, Benjamin Haaland, Adam Hersh, Emily Thorell, Matthew Samore, Karl Madaras-Kelly, Katherine Fleming-Dutra
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s134-s135
- Print publication:
- October 2020
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Background: The Press Ganey (PG) Medical Practice Survey is a commonly used questionnaire for measuring patient experience in healthcare. Our objective was to evaluate the PG surveys completed by caregivers of children presenting for urgent care evaluation of acute respiratory infections (ARIs) to determine any correlation with receipt of antibiotics during their visit. Methods: We evaluated responses to the PG urgent-care surveys for encounters of children <18 years presenting with ARIs (ie, sinusitis, bronchitis, pharyngitis, upper respiratory infection, acute otitis media, or serous otitis media with effusion) within 9 University of Utah urgent-care centers. Scores could range from 0 to 100. Because the distributions of scores followed right- skewed distribution with a high ceiling effect, we defined scores as dissatisfied with their care (≤25th percentile) and satisfied with their care (scores >25th percentile). Univariate and multivariable generalized mixed-effects logistic regression was used to assess correlates of patient dissatisfaction. Random intercepts were included for each provider to account for correlation within the same provider. Separate models were used for each PG component score. Multivariable models adjusted for receipt of antibiotics, age, gender, race, ethnicity, and provider type. Results: Overall, 388 of 520 responses (74.6%) indicated satisfaction and 132 responses (25.4%) indicated dissatisfaction. Among patients who did not receive antibiotics, 87 of 284 responses (30.6%) indicated dissatisfaction versus 45 of 236 (19.1%) who did receive antibiotics. Among patients who were dissatisfied with their clinician, raw clinician PG scores were higher among patients who received antibiotics (mean, 64.5; standard deviation [SD], 16.9) versus those who did not receive antibiotics (mean, 54.7; SD, 24.4; P = .015) (Table 1). In a multivariable analysis, receipt of antibiotics was associated with a reduction in patient dissatisfaction overall (odds ratio, 0.55; 95% CI, 0.36–0.85). Conclusions: Overall, most responses for patients seen for ARIs in pediatric urgent care were satisfied. However, a significantly higher proportion of responses for patients who did not receive antibiotics were dissatisfied than for those patients who received antibiotics. Antibiotic stewardship strategies to communicate appropriate prescribing while preserving patient satisfaction are needed in pediatric urgent-care settings.
Funding: None
Disclosures: None