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Gupta S, Arasaratnam RJ, Solow EB, Bajaj P. A Medical Records Review Study Assessing Safety of Zoster Vaccine Recombinant, Adjuvanted in Patients With Rheumatic Disease. J Clin Rheumatol 2022; 28:e528-e531. [PMID: 34609337 DOI: 10.1097/rhu.0000000000001790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with rheumatic disease are at increased risk for herpes zoster infection. Because of limited safety data in this population and concerns over vaccine-precipitated flares, there are no guidelines for vaccination with the zoster vaccine recombinant, adjuvanted (ZRA). We evaluated self-reported adverse events (AEs) and disease activity after ZRA administration in adults with rheumatic disease. METHODS In this medical records review study at our large academic center, patients who had received at least 1 dose of ZRA from January 1, 2018 to March 11, 2020 were assessed. Self-reported AEs and disease activity were monitored 3 months after each ZRA administration. Measures of disease activity were reviewed 6 months before ZRA in those who received both doses, or 3 months before ZRA in those who received 1 dose. RESULTS We identified 65 patients, of whom 34 (52.3%) received both doses of ZRA. Four patients (6.2%) self-reported AEs after receiving ZRA, all of which were minor and systemic. Three patients (9.2%) developed a flare after receiving ZRA, compared with 8 (12.3%) who experienced a flare in the baseline period. There was no significant change in flare incidence or disease activity after vaccination. Subgroup analysis of those on biologic and nonbiologic disease-modifying antirheumatic drugs revealed no differences in frequency of postvaccination AEs, flares, or disease activity. CONCLUSIONS In our cohort, disease activity seemed stable when comparing disease markers before and after ZRA administration. In addition, ZRA was well-tolerated with minor AEs. Further studies are needed to guide formal vaccination recommendations.
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Affiliation(s)
- Surbhi Gupta
- From the Department of Rheumatic Diseases, University of California, Los Angeles, Los Angeles, CA
| | | | - E Blair Solow
- Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas TX
| | - Puneet Bajaj
- Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas TX
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Abstract
OBJECTIVE This study aimed to develop a trigger tool for detection of neonatal adverse events (AEs) and to validate its effectiveness. STUDY DESIGN Random forest (RF) algorithm was used to build the predictive model by analyzing data from the medical records of 782 neonates in our previous study. Thirteen variables for each patient were used to predict neonatal AEs. Next, the critical variables were selected based on recursive elimination of variables to form the list of triggers. Then, a trigger tool with those triggers was established and tested by reviewing medical records. The positive predictive value of individual triggers and of the entire tool was evaluated. RESULTS Data from 782 neonates, including 297 patients with and 485 patients without AEs, were collected to build the original RF model. Then, the 6 most important variables, including diarrhea, antibiotic use, fever, death, skin damage, and suspected necrotizing enterocolitis, were selected to establish a neonate-focused trigger tool. The forest with the 6 variables predicted AEs with a sensitivity of 70.7%, a specificity of 92.0%, and an error rate of 16.1%. In a validation study of the trigger tool, 655 neonates with birth weights ≥1500 g were enrolled, and review of their medical records revealed 1709 triggers and 1172 unique AEs. The 3 most common AEs identified were skin damage, iatrogenic diarrhea, and environmental factor-related fever. The total positive predictive value of the trigger tool was 0.686. CONCLUSIONS The neonate-focused trigger tool developed using the RF algorithm efficiently and reliably identifies AEs among hospitalized neonates with birth weights ≥1500 g.
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Affiliation(s)
| | - Li Zhang
- From the Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University
| | - Huayun He
- From the Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University
| | | | - Qiannan Zhang
- From the Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University
| | - Hong Wei
- From the Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University
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Chuang TL, Koo M, Chuang MH, Lin CH, Huang CH, Wang YF. Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review. Int J Environ Res Public Health 2022; 19:ijerph19042445. [PMID: 35206633 PMCID: PMC8872367 DOI: 10.3390/ijerph19042445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 02/01/2023]
Abstract
The effect of a vegetarian diet on bone health remains controversial. This retrospective medical record review compared changes in bone mineral density (BMD) and trabecular bone score (TBS) between vegetarian and non-vegetarian middle-aged and older women who underwent two general health examinations (T1 and T2) that were approximately three years apart. Generalized estimating equations were used to compare the change in lumbar spine and bilateral hip BMD and TBS over time. At T1, the mean age of the patients was 56.6 years (standard deviation 9.7 years) and the mean interval between T1 and T2 was 2.7 years. For women aged 40–55 years, compared with non-vegetarians, vegetarians were significantly associated with a larger reduction in lumbar spine BMD (p < 0.001) and left hip femoral neck BMD (p = 0.015) over the three-year interval. On the contrary, changes in BMD were not significant at any site in women aged ≥ 56 years. Moreover, the changes in BMD and TBS over the three-year interval did not significantly differ between vegetarian and non-vegetarian women aged 65–90 years. In conclusion, for women aged 40–55 years, vegetarian diets reduced bone quantity, as measured by BMD, but not bone quality, as measured by TBS.
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Affiliation(s)
- Tzyy-Ling Chuang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (M.-H.C.); (C.-H.L.)
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien 970302, Taiwan;
| | - Mei-Hua Chuang
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (M.-H.C.); (C.-H.L.)
- Faculty of Pharmacy, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei 25245, Taiwan
| | - Chun-Hung Lin
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (M.-H.C.); (C.-H.L.)
- Department of General Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan
| | - Chin-Huan Huang
- Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan;
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622401, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (M.-H.C.); (C.-H.L.)
- Correspondence: ; Tel.: +886-5-2648000 (ext. 5700)
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204
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Chen L, Xia T, Yuan ZA, Rampatige R, Chen J, Li H, Adair T, Yu HT, Bratschi M, Setel P, Rajasekhar M, Chowdhury HR, Gamage SH, Fang B, Azam O, Santon R, Gu Z, Tan Z, Wang C, Lopez AD, Wu F. Are cause of death data for Shanghai fit for purpose? A retrospective study of medical records. BMJ Open 2022; 12:e046185. [PMID: 35168960 PMCID: PMC8852669 DOI: 10.1136/bmjopen-2020-046185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess the quality of cause of death reporting in Shanghai for both hospital and home deaths. DESIGN AND SETTING Medical records review (MRR) to independently establish a reference data set against which to compare original and adjusted diagnoses from a sample of three tertiary hospitals, one secondary level hospital and nine community health centres in Shanghai. PARTICIPANTS 1757 medical records (61% males, 39% females) of deaths that occurred in these sample sites in 2017 were reviewed using established diagnostic standards. INTERVENTIONS None. PRIMARY OUTCOME Original underlying cause of death (UCOD) from medical facilities. SECONDARY OUTCOME Routine UCOD assigned from the Shanghai Civil Registration and Vital Statistics (CRVS) system and MRR UCODs from MRR. RESULTS The original UCODs as assigned by doctors in the study facilities were of relatively low quality, reduced to 31% of deaths assigned to garbage codes, reduced to 2.3% following data quality and follow back procedures routinely applied by the Shanghai CRVS system. The original UCOD had lower chance-corrected concordance and cause-specific mortality fraction accuracy of 0.57 (0.44, 0.70) and 0.66, respectively, compared with 0.75 (0.66, 0.85) and 0.96, respectively, after routine data checking procedures had been applied. CONCLUSIONS Training in correct death certification for clinical doctors, especially tertiary hospital doctors, is essential to improve UCOD quality in Shanghai. A routine quality control system should be established to actively track diagnostic performance and provide feedback to individual doctors or facilities as needed.
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Affiliation(s)
- Lei Chen
- Vitral Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Tian Xia
- Division of Public Health and Program Management, Shanghai Institute of Preventive Medicine, Shanghai, China
| | - Zheng-An Yuan
- Central Office, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Rasika Rampatige
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jun Chen
- Cancer Registration and Civil Statistic, Shanghai Putuo District Center for Disease Control and Prevention, Shanghai, China
| | - Hang Li
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Adair
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hui-Ting Yu
- Vitral Statistics, Shanghai Institute of Preventive Medicine, Shanghai, China
| | - Martin Bratschi
- Public Health Programs, Vital Strategies, New York, New York, USA
| | - Philip Setel
- Public Health Programs, Vital Strategies, New York, New York, USA
| | - Megha Rajasekhar
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - H R Chowdhury
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Saman Hattotuwa Gamage
- Melbourne School Of Population And Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bo Fang
- Vitral Statistics, Shanghai Institute of Preventive Medicine, Shanghai, China
| | - Omair Azam
- Public Health Programs, Vital Strategies, New York, New York, USA
| | - Romain Santon
- Public Health Programs, Vital Strategies, New York, New York, USA
| | - Zhen Gu
- Public Health Programs, Vital Strategies, New York, New York, USA
| | - Ziwen Tan
- Vitral Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chunfang Wang
- Vitral Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Alan D Lopez
- IHME, University of Washington, Seattle, Washington, USA
| | - Fan Wu
- Shanghai Medical College, Fudan University, Shanghai, China
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205
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Jian J, Yu P, Zheng-Li C, Hao L, Ze-Jing W, Shao-Shuo Y, Yu S, Guang-Yi W, Shi-Hui Z, Bing M, Zhao-Fan X. Epidemiological retrospective analysis in major burn patients: single centre medical records from 2009 to 2019. Updates Surg 2022; 74:1453-1459. [PMID: 35147858 DOI: 10.1007/s13304-021-01215-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
Burns cause a loss of skin barrier function, rendering it prone to infection. The prevention of infection comprises a focus on the treatment of patients with burns. Therefore, we analysed the results of microbiological tests of patients with severe and extremely severe burns to provide a basis for the prevention and treatment of infection in patients with burns. The results of microbiological tests of patients with severe and extremely severe burns admitted to our burn centre between 2009 and 2019 were retrospectively reviewed. The overall positive rate of microbial detection was 40.67% and did not significantly decline over the 10-year study period. The most common positive sites were wounds, sputum, and urine. The most common bacterial species causing the infections were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Furthermore, the predictors of a positive detection, overall and at various sites, mainly included the burn area and depth, inhalation injury, and length of the hospital stay. Positive detection was an important predictor of the prognosis. In particular, a positive blood culture and Klebsiella pneumoniae had better predictive strength for mortality than other sites and strains. This study analysed the microbiological testing results at a single burn centre over a period of 10 years. The results provide information regarding the predictors of a positive detection and the influence of a positive detection on prognosis, and can be used as a basis for the development of clinical infection prevention and treatment strategies, as well as the selection of treatment measures.
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Affiliation(s)
- Jin Jian
- 903rd Hospital of People Liberation Army (PLA), Hangzhou, Zhejiang, China
| | - Peng Yu
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Chen Zheng-Li
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Lu Hao
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Wang Ze-Jing
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Yu Shao-Shuo
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Sun Yu
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Wang Guang-Yi
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Zhu Shi-Hui
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Ma Bing
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China.
| | - Xia Zhao-Fan
- The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China.
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206
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Yu G, Zhang L, Zhang Y, Zhou J, Zhang T, Bi X. Prediction and risk stratification from hospital discharge records based on Hierarchical sLDA. BMC Med Inform Decis Mak 2022; 22:14. [PMID: 35033059 PMCID: PMC8760773 DOI: 10.1186/s12911-022-01747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The greatly accelerated development of information technology has conveniently provided adoption for risk stratification, which means more beneficial for both patients and clinicians. Risk stratification offers accurate individualized prevention and therapeutic decision making etc. Hospital discharge records (HDRs) routinely include accurate conclusions of diagnoses of the patients. For this reason, in this paper, we propose an improved model for risk stratification in a supervised fashion by exploring HDRs about coronary heart disease (CHD). METHODS We introduced an improved four-layer supervised latent Dirichlet allocation (sLDA) approach called Hierarchical sLDA model, which categorized patient features in HDRs as patient feature-value pairs in one-hot way according to clinical guidelines for lab test of CHD. To address the data missing and imbalance problem, RFs and SMOTE methods are used respectively. After TF-IDF processing of datasets, variational Bayes expectation-maximization method and generalized linear model were used to recognize the latent clinical state of a patient, i.e., risk stratification, as well as to predict CHD. Accuracy, macro-F1, training and testing time performance were used to evaluate the performance of our model. RESULTS According to the characteristics of our datasets, i.e., patient feature-value pairs, we construct a supervised topic model by adding one more Dirichlet distribution hyperparameter to sLDA. Compared with established supervised algorithm Multi-class sLDA model, we demonstrate that our proposed approach enhances training time by 59.74% and testing time by 25.58% but almost no loss of average prediction accuracy on our datasets. CONCLUSIONS A model for risk stratification and prediction of CHD based on sLDA model was proposed. Experimental results show that Hierarchical sLDA model we proposed is competitive in time performance and accuracy. Hierarchical processing of patient features can significantly improve the disadvantages of low efficiency and time-consuming Gibbs sampling of sLDA model.
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Affiliation(s)
- Guanglei Yu
- School of Medical Engineering and Technology, Xinjiang Medical University, No.567 North Shangde Road, Urumqi, China
| | - Linlin Zhang
- College of Information Science and Engineering, Xinjiang University, Urumqi, China
| | - Ying Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jiaqi Zhou
- School of Medical Engineering and Technology, Xinjiang Medical University, No.567 North Shangde Road, Urumqi, China
| | - Tao Zhang
- School of Medical Engineering and Technology, Xinjiang Medical University, No.567 North Shangde Road, Urumqi, China
| | - Xuehua Bi
- School of Medical Engineering and Technology, Xinjiang Medical University, No.567 North Shangde Road, Urumqi, China.
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207
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Su KQ, Gao J, Li JY, Yuan J, Liu HH, Li RQ, Feng XD. [Acupoint selection rules of post-stroke cognitive impairment treated with acupuncture based on ancient and modern medical record cloud platform]. Zhongguo Zhen Jiu 2022; 42:99-103. [PMID: 35025165 DOI: 10.13703/j.0255-2930.20201123-k0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the acupoint selection rules of post-stroke cognitive impairment (PSCI) treated with acupuncture by ancient and modern medical record cloud platform (V1.5). METHODS The published randomized controlled trial (RCT) literature of PSCI treated with acupuncture was retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library and Web of Science, and the data was extracted to establish prescription database. The ancient and modern medical record cloud platform (V1.5) was used to analyze the data. RESULTS A total of 185 articles was included, involving 91 acupoints, the total using frequency was 1174 times. The top 5 acupoints in frequency of PSCI treated with acupuncture were Baihui (GV 20, 151 times), Shenting (GV 24, 97 times), Sishencong (EX-HN 1, 83 times), Neiguan (PC 6, 69 times) and Sanyinjiao (SP 6, 64 times); the most involved meridian was the governor vessel, and the generally used acupoints were mainly distributed in the head, face and neck. The top 5 acupoint combinations in frequency were Baihui (GV 20)-Shenting (GV 24, 89 times), Baihui (GV 20)-Sishencong (EX-HN 1, 79 times), Baihui (GV 20)-Neiguan (PC 6, 59 times), Baihui (GV 20)-Sanyinjiao (SP 6, 56 times) and Baihui (GV 20)-Zusanli (ST 36, 51 times). The acupoint combination with the strongest association was Shenting (GV 24)→Baihui (GV 20). There were 6 acupoint cluster groups according to the cluster analysis, and the main core prescription was Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), Zusanli (ST 36), Neiguan (PC 6) and Sanyinjiao (SP 6). CONCLUSION Acupoints on the governor vessel, and distributed in head, face and neck are the main acupoints for PSCI treated with acupuncture, Baihui (GV 20), Shenting (GV 24), Sishencong (EX-HN 1), Zusanli (ST 36), Neiguan (PC 6) and Sanyinjiao (SP 6) can be used as the main acupoints, but it is still necessary to combine with syndrome differentiation.
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Affiliation(s)
- Kai-Qi Su
- First Clinical Medical College, Henan University of CM, Zhengzhou 450046, China; Rehabilitation Center, First Affiliated Hospital of Henan University of CM, Zhengzhou 450000
| | - Jing Gao
- Rehabilitation Center, First Affiliated Hospital of Henan University of CM, Zhengzhou 450000; School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
| | - Jie-Ying Li
- School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
| | - Jie Yuan
- School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
| | - Huan-Huan Liu
- School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
| | - Rui-Qing Li
- Rehabilitation Center, First Affiliated Hospital of Henan University of CM, Zhengzhou 450000; School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
| | - Xiao-Dong Feng
- Rehabilitation Center, First Affiliated Hospital of Henan University of CM, Zhengzhou 450000; School of Rehabilitation Medicine, Henan University of CM, Zhengzhou 450046
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208
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Izmaylova ZM, Vagner VD, Kuzin AV. [Analysis of medical records as an element of quality control and safety of medical activities]. Stomatologiia (Mosk) 2022; 101:100-105. [PMID: 35362711 DOI: 10.17116/stomat2022101021100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Studying the issue of quality control and safety of medical activities. MATERIAL AND METHODS The analysis of domestic literature on the quality of filling out medical documentation has been carried out. RESULTS A dental patient's medical record (ICSD) is not only the most important legal document, but also a certain indicator of the level of professional competence of a dentist. To find out all sorts of reasons that led to professional errors and adverse consequences after the provision of dental care, a thorough study and general analysis of medical documentation is of great importance, the maintenance and correct execution of which is also necessary for solving a number of other, including legal issues. The most common drawbacks in the design of a dental patient's medical record have been identified, which indicates a decrease in the quality of medical care provided to patients. CONCLUSION At the moment, there are still unresolved issues related to complete completion of medical documentation. When analyzing the literature, we did not find a purposeful study of the medical history of a dental patient during surgical treatment, which requires further research.
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Affiliation(s)
- Z M Izmaylova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V D Vagner
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - A V Kuzin
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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209
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Santarelli IM. [The educational power of the medical record]. Medicina (B Aires) 2022; 82:159-160. [PMID: 35037877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Ignacio M Santarelli
- Departamento de Medicina, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina. E-mail:
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210
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Howe LK, Copeland S, Fisher L, Farmer E, Nemes L, Finn PR. Mobile assessment of decisions to drink in young adults: Examining the role of incentives and disincentives. Alcohol Clin Exp Res 2022; 46:152-165. [PMID: 34806196 PMCID: PMC8799506 DOI: 10.1111/acer.14746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Research on decision-making (DM) biases in persons with alcohol use disorder have largely relied on behavioral economic DM tasks, which do not assess the dynamic multitude of factors associated with real-world decisions about drinking. The current study extends the literature on DM and alcohol use by using a mobile daily diary approach to investigate whether, and how, real-world incentives and disincentives are associated with actual drinking decisions in college students. METHODS We assessed current drinking and lifetime alcohol problems in 104 young adults (61.5% female, 84.5% White) who, for 14 days, used a mobile daily diary to respond to questions about drinking decisions from the day prior. Mobile prompts assessed daily data on the timing of drinking decisions, alcohol quantity initially decided to drink, quantity actually decided to drink, and the incentives that influenced drinking decisions. RESULTS Users of the app reported high usability, high compliance rates were observed, and incentive responses were reduced to three subtypes: alcohol, social/party, and mood. Daily mobile measures of drinking quantity were strongly correlated with self-reported drinking 2 weeks prior to the daily assessment. Lifetime alcohol problems were positively related to the average quantity decided to drink per event, drinking more than initially decided, and higher levels of self-reported drinking-decision incentives. "Alcohol" and "social/party" incentives were positively related to the quantity the participant decided to drink at drinking events. Mood incentives and disincentives showed little to no significant relationships with drinking decisions. CONCLUSIONS The results suggest that mobile data collection can be useful for assessing aspects of real-world drinking decisions and the influence of multiple drinking decision incentives.
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Affiliation(s)
- Lindy K Howe
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Savanna Copeland
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Lindsey Fisher
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Eli Farmer
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Luca Nemes
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA
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211
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Affiliation(s)
- Allan S Brett
- From the Department of Medicine, University of Colorado School of Medicine, Aurora (A.S.B.); and the Department of Medicine, University of South Carolina School of Medicine, Columbia (C.W.G.)
| | - Christopher W Goodman
- From the Department of Medicine, University of Colorado School of Medicine, Aurora (A.S.B.); and the Department of Medicine, University of South Carolina School of Medicine, Columbia (C.W.G.)
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212
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Brogan J, López MDPA, Tokashiki H, Celi LA. Scalable data systems require creating a culture of continuous learning. EBioMedicine 2021; 74:103738. [PMID: 34922905 PMCID: PMC8720833 DOI: 10.1016/j.ebiom.2021.103738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- James Brogan
- Albert Einstein College of Medicine, Bronx, NY, United States.
| | | | - Harumi Tokashiki
- Tufts University School of Medicine, Carney Hospital, Boston, MA, United States.
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States 02139; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States, 02115.
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Lai HF, Yeh JY, Cheng YW, Lin CL. Building an Integrated Radiotherapy Information System to Improve Patient Safety. Stud Health Technol Inform 2021; 284:318-319. [PMID: 34920534 DOI: 10.3233/shti210731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In our hospital, the medical records of patients receiving tumor radiotherapy were paper-base. The purpose of this study was to develop an integrated radiotherapy information system to improve the quality and efficiency of treatment for patients with cancer. What's more, it's expected that the system can reduce time and errors caused by manual record.
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Affiliation(s)
- Hsiang-Fen Lai
- Department of Nursing, Yeezen General Hospital, Taoyuan, Taiwan, ROC
| | - Jia-Yi Yeh
- Department of Radiation Oncology, Yeezen General Hospital, Taoyuan, Taiwan, ROC
| | - Yu-Wei Cheng
- Department of Information, Yeezen General Hospital, Taoyuan, Taiwan, ROC
| | - Chu-Lan Lin
- Department of Information, Yeezen General Hospital, Taoyuan, Taiwan, ROC
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214
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Næss AB, Bjørke J. Patients have access to medical records. Tidsskr Nor Laegeforen 2021; 141:21-0778. [PMID: 34911259 DOI: 10.4045/tidsskr.21.0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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215
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Fritz Z, Griffiths FE, Slowther AM. Custodians of Information: Patient and Physician Views on Sharing Medical Records in the Acute Care Setting. Health Commun 2021; 36:1879-1888. [PMID: 32814466 PMCID: PMC8601592 DOI: 10.1080/10410236.2020.1803553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the UK, in the acute in-patient setting, the only information that a patient receives about their medical care is verbal; there is no routine patient access to any part of the medical record. It has been suggested that this should change, so that patients can have real-time access to their notes, but no one has previously explored patient or clinician views on the impact this might have. Semi-structured interviews were conducted with 12 patients and 13 doctors about their experience of information sharing in the context of the acute care setting, and their views on sharing all of the medical records, or a summary note. Interviews were transcribed verbatim, double coded and analyzed using the constant comparative method. Patients were not given written information and did not ask questions even when they wanted to know things. Patients and doctors supported increased sharing of written information, but the purpose of the medical record - and the risks and benefits of sharing it - were disputed. Concerns included disclosing uncertainty, changing what was written, and causing patient anxiety. Benefits included increased transparency. Use of a summary record was welcomed as a way to empower patients, while doctors felt they had a responsibility to curate what information was given and when. A clinical summary for patients would be of benefit to doctors, nurses, patients and their relatives. It should be designed to reflect the needs of all users, and evaluated to consider patient-relevant outcomes and resource implications.
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Affiliation(s)
- Zoe Fritz
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge
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216
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Chen C, Hie SL, Ng AS. Maintaining Updated Patient's Medication Records: Introduction of an Order-on-Behalf Service by Pharmacists. J Patient Saf 2021; 17:e1138-e1144. [PMID: 30807435 DOI: 10.1097/pts.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Accurate medication records are integral to healthcare, especially for obstetrics and gynecology and pediatric patients. When pharmacists perform verbal interventions with prescribers, these were often not updated in the patients' medication records. To address this issue, the order-on-behalf (OOB) service by pharmacists was implemented in late November 2015, with the aim of providing timely updates of patients' medication records. The impact of service will be evaluated in this article. METHODS The OOB records from December 2015 to April 2017 were collected and reviewed. Details collected include patient type, date performed, date of prescription, and details of interventions. Respective pharmacists who entered the orders were approached for further clarifications, where required. This was a process improvement project exempted from review. RESULTS A total of 1501 entries (824 for women, 677 for children) were reviewed. Top three medication-related problems identified were inappropriate dosage regimen (845), improper drug selection (185), and therapeutic substitution (226). The most commonly implicated drugs were hormones (28%) and antibiotics (18%) for obstetrics and gynecology-related entries and antibiotics (27%) and antiepileptic drugs (6%) for pediatric-related entries. CONCLUSIONS The OOB service has updated many patients' medication records. Having updated records enhances patient safety because it provides the most accurate information for the prescribers at the next patient visit. Review of OOB data identified the most common types of medication-related problems, as well as the patient subtypes involved. This provides a platform for future work to be performed on system optimizations to improve patient safety.
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Abstract
INTRODUCTION Thorough documentation is of utmost importance in a patient hospital experience. It forms an accurate record of an inpatient stay, facilitates handover between medical colleagues, and is also a legal document. Medical notes tend to be detailed and insightful on admission, but the daily ward round notes have often fallen short of expectation. With most patient records entered by junior level of staff, it is important to ensure that adequate documentation occurs. METHODS We analyzed notes entered in patient charts at set periods and compared them against standards set out in the Royal College of Surgeons Ireland and England, as well as Medical Council guidelines from the two countries. After this, a pro forma was established to standardize the medical record keeping on patient ward rounds. Compliance with guidelines was assessed by comparing notes before introduction of the pro forma and after their introduction. RESULTS Before its introduction, 0% of notes fulfilled the full criteria selected for the pro forma documentation. After intervention, there was a good initial response, with notes capturing an average 86% of the required information. A reaudit of compliance 2 months after introduction showed a 9% decrease of information completeness to 75%. CONCLUSIONS Introduction of a pro forma for the documentation of daily ward rounds improved compliance of ward round notes when compared with internationally recognized guidelines, with no additional time required during ward rounds. Despite improved compliance, continued effort is needed to achieve a better standard of care.
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Affiliation(s)
- Danilo Vukanic
- From the Department of Trauma and Orthopaedic Surgery, University Hospital Waterford
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Abstract
OBJECTIVE In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods. METHODS We searched Embase, PubMed, and Cochrane databases for studies (2000-2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately. RESULTS Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average €4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE. CONCLUSIONS Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.
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Affiliation(s)
- Dorthe O. Klein
- From the Departments of Clinical Epidemiology and Medical Technology Assessment (KEMTA)
| | | | | | - Martin H. Prins
- Department of Epidemiology, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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Methaneethorn J, Lohitnavy M, Onlamai K, Leelakanok N. Predictive Performance of Published Tacrolimus Population Pharmacokinetic Models in Thai Kidney Transplant Patients. Eur J Drug Metab Pharmacokinet 2021; 47:105-116. [PMID: 34817826 DOI: 10.1007/s13318-021-00735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Tacrolimus is a narrow therapeutic index drug with high pharmacokinetic variability, and several tacrolimus population pharmacokinetic (PopPK) models were developed to guide individualized drug dosing. These models, however, may not perform well in other clinical settings. Therefore, we aimed to assess the predictive ability of published tacrolimus PopPK models using a dataset of Thai kidney transplant patients. METHODS The external dataset was retrospectively collected from medical records of Bhumibol Adulyadej Hospital, Thailand. Published tacrolimus PopPK models were systematically searched from PubMed, Science Direct, CINAHL Complete, and Scopus databases. Models conducted using a nonlinear mixed-effects approach with covariate resemblance to our external dataset were selected. The external dataset consisted of Thai kidney transplant patients receiving oral immediate- or extended-release tacrolimus formulations twice or once daily, respectively. Accuracy and precision of predicted concentrations were evaluated using mean absolute prediction error (MAPE), root mean square error (RMSE), and goodness of fit plots. RESULTS Only three models produced acceptable population predictions with the MAPE of < 50%. By using the Bayesian posthoc estimate of individual pharmacokinetic parameters, all models well performed with the MAPE and RMSE of < 30% and 40%, respectively, except two models; one could not successfully converge and the other substantially underpredicted tacrolimus concentrations. CONCLUSION We evaluated ten tacrolimus PopPK models, and eight models resulted in satisfactorily individual predicted tacrolimus concentrations in Thai kidney transplant patients and may be used to aid tacrolimus dose adjustment along with a clinical judgment.
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Affiliation(s)
- Janthima Methaneethorn
- Pharmacokinetic Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000, Thailand.
- Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand.
| | - Manupat Lohitnavy
- Pharmacokinetic Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 65000, Thailand
- Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| | - Kamonwan Onlamai
- Department of Pharmacy, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Nattawut Leelakanok
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
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Tischlik V, Mehl C, Ewald D, Heinzel-Gutenbrunner M, Geraedts M, Bachmann CJ. Assessment of the quality of routine ambulatory healthcare for common disorders in children and adolescents in Germany: study protocol for a retrospective medical record review (QualiPäd). BMJ Open 2021; 11:e048782. [PMID: 34815275 PMCID: PMC8611448 DOI: 10.1136/bmjopen-2021-048782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders. METHODS AND ANALYSIS Quality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models. ETHICS AND DISSEMINATION This study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences. TRIAL REGISTRATION NUMBER DRKS00022408.
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Affiliation(s)
- Viktor Tischlik
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
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Teklewold B, Knfe G, Dandena F. Improving Completeness of Surgical Inpatient Medical Records in Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Hosp Top 2021; 101:208-214. [PMID: 34807810 DOI: 10.1080/00185868.2021.2005500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients' medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention. METHODS surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards. RESULT A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p < 0.05). CONCLUSION AND RECOMMENDATION Study has shown that small and persistent quality improvement interventions that focus on continuous evaluation, leadership engagement, and innovative strategies bring significant improvement in record completeness.
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Affiliation(s)
- Berhanetsehay Teklewold
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goytom Knfe
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Firaol Dandena
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Hung H, Kueh LL, Tseng CC, Huang HW, Wang SY, Hu YN, Lin PY, Wang JL, Chen PF, Liu CC, Roan JN. Assessing the quality of electronic medical records as a platform for resident education. BMC Med Educ 2021; 21:577. [PMID: 34774027 PMCID: PMC8590775 DOI: 10.1186/s12909-021-03011-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Previous studies have assessed note quality and the use of electronic medical record (EMR) as a part of medical training. However, a generalized and user-friendly note quality assessment tool is required for quick clinical assessment. We held a medical record writing competition and developed a checklist for assessing the note quality of participants' medical records. Using the checklist, this study aims to explore note quality between residents of different specialties and offer pedagogical implications. METHODS The authors created an inpatient checklist that examined fundamental EMR requirements through six note types and twenty items. A total of 149 records created by residents from 32 departments/stations were randomly selected. Seven senior physicians rated the EMRs using a checklist. Medical records were grouped as general medicine, surgery, paediatric, obstetrics and gynaecology, and other departments. The overall and group performances were analysed using analysis of variance (ANOVA). RESULTS Overall performance was rated as fair to good. Regarding the six note types, discharge notes (0.81) gained the highest scores, followed by admission notes (0.79), problem list (0.73), overall performance (0.73), progress notes (0.71), and weekly summaries (0.66). Among the five groups, other departments (80.20) had the highest total score, followed by obstetrics and gynaecology (78.02), paediatrics (77.47), general medicine (75.58), and surgery (73.92). CONCLUSIONS This study suggested that duplication in medical notes and the documentation abilities of residents affect the quality of medical records in different departments. Further research is required to apply the insights obtained in this study to improve the quality of notes and, thereby, the effectiveness of resident training.
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Affiliation(s)
- Hsuan Hung
- Tainan Municipal North District Kaiyuan Elementary School, Tainan, Taiwan
| | - Ling-Ling Kueh
- Institute of Education, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Chung Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Han-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Yen Wang
- Quality Center, National Cheng Kung University Hospital, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Yu-Ning Hu
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pao-Yen Lin
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Fan Chen
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jun-Neng Roan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Ishida T, Hagiya H, Honda H, Nakano Y, Ogawa H, Obika M, Ueda K, Kataoka H, Hanayama Y, Otsuka F. Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study. PLoS One 2021; 16:e0259633. [PMID: 34767587 PMCID: PMC8589193 DOI: 10.1371/journal.pone.0259633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.
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Affiliation(s)
- Tomoharu Ishida
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Hiroyuki Honda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Hiroko Ogawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Mikako Obika
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Hitomi Kataoka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kitaku, Okayama, Japan
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Ibarra-Barrueta O, Ibarra-García E, Pérez-Díez E. Implementation of a pharmacy e-interconsultation integrated in patient medical record. Eur J Hosp Pharm 2021; 28:e124-e127. [PMID: 33199397 PMCID: PMC8640424 DOI: 10.1136/ejhpharm-2020-002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 08/23/2020] [Accepted: 09/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the phases of development and the success of implementation of the pharmacist non-face-to-face consultation in primary and hospital setting. METHOD A descriptive and retrospective study was conducted to implement pharmacist non-face-to-face consultation with the clinician, integrated in the patient medical record. A working group was created to define content of the consultation, time of answer and the pharmacist appointment schedule integrated in the patient record. The number and type of consultations and pharmacist documentations were measure during the study period. RESULTS 530 non-face-to-face consultations were collected from April 2018 to September 2019, principally from hospital setting, but also from primary care. The main motive of consultation was high cost drugs application. The pharmacist documentations in medical record increased after non-face-to-face consultation implementation from 98 in the prior period to 375 afterwards. As a conclusion, pharmacist non-face-to-face consultation has been successfully implemented in our health area, enhancing pharmacist presence in patient medical record and improving the communication between the pharmacists and the physicians.
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Affiliation(s)
| | | | - Estibaliz Pérez-Díez
- Pharmacy Department, Hospital de Urduliz Alfredo Espinosa, Urduliz, Biscay, Spain
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Romero Gomez AF, Orjuela-Canon AD, Jutinico AL, Awad C, Vergara E, Palencia A. Preliminary Text Analysis from Medical Records for TB Diagnosis Support. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2468-2471. [PMID: 34891779 DOI: 10.1109/embc46164.2021.9631006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Tuberculosis is an infectious disease that is spread through the air from one person to another and is one of the top ten causes of death in the world according to the World Health Organization. From biomedical engineering, decision support systems based on artificial intelligence have shown advantages for healthcare personnel in tasks such as diagnosis and screening. A specific area of the artificial intelligence is the natural language processing, however, most of these approaches are based on available data. This paper shows the construction of a dataset based on medical records of subjects suspected of tuberculosis. In addition, an initial exploration of the contents of the constructed dataset and how this approach can be followed by a natural language processing to support tuberculosis diagnosis in data demanding scenarios are presented.Clinical Relevance- In some developing countries as Colombia, it is difficult to develop systems based on artificial intelligence due to the availability of data. This proposal holds a strategy to build a dataset to train machine learning models, and to obtain support diagnosis tools, employing natural language from the medical scenario from text written by health professionals in the medical record. In this way, trained models based on this information available can be employed in places where medical infrastructure is precarious.
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Dong H, Suarez-Paniagua V, Zhang H, Wang M, Whitfield E, Wu H. Rare Disease Identification from Clinical Notes with Ontologies and Weak Supervision. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2294-2298. [PMID: 34891745 DOI: 10.1109/embc46164.2021.9630043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The identification of rare diseases from clinical notes with Natural Language Processing (NLP) is challenging due to the few cases available for machine learning and the need of data annotation from clinical experts. We propose a method using ontologies and weak supervision. The approach includes two steps: (i) Text-to-UMLS, linking text mentions to concepts in Unified Medical Language System (UMLS), with a named entity linking tool (e.g. SemEHR) and weak supervision based on customised rules and Bidirectional Encoder Representations from Transformers (BERT) based contextual representations, and (ii) UMLS-to-ORDO, matching UMLS concepts to rare diseases in Orphanet Rare Disease Ontology (ORDO). Using MIMIC-III US intensive care discharge summaries as a case study, we show that the Text-to-UMLS process can be greatly improved with weak supervision, without any annotated data from domain experts. Our analysis shows that the overall pipeline processing discharge summaries can surface rare disease cases, which are mostly uncaptured in manual ICD codes of the hospital admissions.
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van Casteren DS, Verhagen IE, van der Arend BWH, van Zwet EW, MaassenVanDenBrink A, Terwindt GM. Comparing Perimenstrual and Nonperimenstrual Migraine Attacks Using an e-Diary. Neurology 2021; 97:e1661-e1671. [PMID: 34493613 PMCID: PMC8605615 DOI: 10.1212/wnl.0000000000012723] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/05/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Endogenous and exogenous female sex hormones are considered important contributors to migraine pathophysiology. Previous studies have cautiously suggested that perimenstrual migraine attacks have a longer duration and are associated with higher disability compared to nonperimenstrual attacks, but they showed conflicting results on acute therapy efficacy, pain intensity, and associated symptoms. We compared perimenstrual and nonperimenstrual migraine attack characteristics and assessed premenstrual syndrome (PMS) in women with migraine. METHODS Women with migraine were invited to complete a headache e-diary. Characteristics of perimenstrual attacks and nonperimenstrual attacks were compared. The primary outcome was attack duration. Secondary outcomes were headache intensity, accompanying symptoms, acute medication intake, and pain coping. Mixed effects models were used to account for multiple attacks within patients. PMS was assessed in patients without hormonal contraceptives. Subgroup analyses were performed for women with menstrually related migraine (MRM) and nonmenstrually related migraine (non-MRM) and women with a natural menstrual cycle and women using hormonal contraceptives. RESULTS A representative group of 500 participants completed the e-diary for at least 1 month. Perimenstrual migraine attacks (n = 998) compared with nonperimenstrual attacks (n = 4097) were associated with longer duration (20.0 vs 16.1 hours, 95% confidence interval 0.2-0.4), higher recurrence risk (odds ratio [OR] 2.4 [2.0-2.9]), increased triptan intake (OR 1.2 [1.1-1.4]), higher headache intensity (OR 1.4 [1.2-1.7]), less pain coping (mean difference -0.2 [-0.3 to -0.1]), more pronounced photophobia (OR 1.3 [1.2-1.4]) and phonophobia (OR 1.2 [1.1-1.4]), and less aura (OR 0.8 [0.6-1.0]). In total, 396/500 women completed the diary for ≥3 consecutive menstrual cycles, of whom 56% (221/396) fulfilled MRM criteria. Differences in attack characteristics became more pronounced when focusing on women with MRM and women using hormonal contraceptives. Prevalence of PMS was not different for women with MRM compared to non-MRM (11% vs 15%). DISCUSSION The longer duration of perimenstrual migraine attacks in women (with MRM) is associated with higher recurrence risk and increased triptan use. This may increase the risk of medication overuse and emphasizes the need to develop female-specific prophylactic treatment.
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Affiliation(s)
- Daphne S van Casteren
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Iris E Verhagen
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Britt W H van der Arend
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik W van Zwet
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antoinette MaassenVanDenBrink
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gisela M Terwindt
- From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
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Katsanis SH, Claes P, Doerr M, Cook-Deegan R, Tenenbaum JD, Evans BJ, Lee MK, Anderton J, Weinberg SM, Wagner JK. A survey of U.S. public perspectives on facial recognition technology and facial imaging data practices in health and research contexts. PLoS One 2021; 16:e0257923. [PMID: 34648520 PMCID: PMC8516205 DOI: 10.1371/journal.pone.0257923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Facial imaging and facial recognition technologies, now common in our daily lives, also are increasingly incorporated into health care processes, enabling touch-free appointment check-in, matching patients accurately, and assisting with the diagnosis of certain medical conditions. The use, sharing, and storage of facial data is expected to expand in coming years, yet little is documented about the perspectives of patients and participants regarding these uses. We developed a pair of surveys to gather public perspectives on uses of facial images and facial recognition technologies in healthcare and in health-related research in the United States. We used Qualtrics Panels to collect responses from general public respondents using two complementary and overlapping survey instruments; one focused on six types of biometrics (including facial images and DNA) and their uses in a wide range of societal contexts (including healthcare and research) and the other focused on facial imaging, facial recognition technology, and related data practices in health and research contexts specifically. We collected responses from a diverse group of 4,048 adults in the United States (2,038 and 2,010, from each survey respectively). A majority of respondents (55.5%) indicated they were equally worried about the privacy of medical records, DNA, and facial images collected for precision health research. A vignette was used to gauge willingness to participate in a hypothetical precision health study, with respondents split as willing to (39.6%), unwilling to (30.1%), and unsure about (30.3%) participating. Nearly one-quarter of respondents (24.8%) reported they would prefer to opt out of the DNA component of a study, and 22.0% reported they would prefer to opt out of both the DNA and facial imaging component of the study. Few indicated willingness to pay a fee to opt-out of the collection of their research data. Finally, respondents were offered options for ideal governance design of their data, as "open science"; "gated science"; and "closed science." No option elicited a majority response. Our findings indicate that while a majority of research participants might be comfortable with facial images and facial recognition technologies in healthcare and health-related research, a significant fraction expressed concern for the privacy of their own face-based data, similar to the privacy concerns of DNA data and medical records. A nuanced approach to uses of face-based data in healthcare and health-related research is needed, taking into consideration storage protection plans and the contexts of use.
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Affiliation(s)
- Sara H. Katsanis
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Peter Claes
- Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium
- Medical Imaging Research Center, MIRC, KU Leuven, Leuven, Belgium
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Megan Doerr
- Sage Bionetworks, Seattle, Washington, United States of America
| | - Robert Cook-Deegan
- School for the Future of Innovation in Society, Arizona State University, Washington, District of Columbia, United States of America
| | - Jessica D. Tenenbaum
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Barbara J. Evans
- Levin College of Law, University of Florida, Gainesville, Florida, United States of America
- Wertheim College of Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Myoung Keun Lee
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Joel Anderton
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Seth M. Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jennifer K. Wagner
- School of Engineering Design, Technology, and Professional Programs, Pennsylvania State University, University Park, Pennsylvania, United States of America
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Dove ES, Taylor MJ. Signalling Standards for Progress: Bridging the Divide Between a Valid Consent to Use Patient Data Under Data Protection Law and the Common Law Duty of Confidentiality. Med Law Rev 2021; 29:411-445. [PMID: 34270741 PMCID: PMC8500295 DOI: 10.1093/medlaw/fwab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article, we analyse the legal components of disclosing confidential patient information under the UK's common law duty of confidentiality (CLDoC) and processing personal (health) data under the UK's General Data Protection Regulation (GDPR) and Data Protection Act 2018. We describe the ostensible divide between the CLDoC and data protection law when it comes to the requirements of a valid signal of consent by a patient to use and disclose patient information, obtained by a health professional in the context of direct care, for health care and health research purposes. Ultimately, our analysis suggests that we are saddled, at least in the medium term, with two regimes operating with different standards of a valid consent-while putatively protecting similar interests. There is, however, opportunity for progress. It is possible to improve professional guidance on the interaction between the regimes and to achieve significant normative alignment without aligning the signalling standard for consent; this would promote consistent protection of reasonable expectations of patients across both regimes. Further coherence would require aligning not only the standard, but also the role played by consent under each regime. Here we argue that, in relation to direct care, any such shift should be away from consent as the normal justification. In relation to health research, on the contrary, it should be toward consent as the normal justification for use and disclosure of patient information under both the CLDoC and data protection law.
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Affiliation(s)
| | - Mark J Taylor
- Melbourne Law School, University of Melbourne, Australia
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231
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Saikali M, Tanios A, Saab A. Evaluation of a Broad-Spectrum Partially Automated Adverse Event Surveillance System: A Potential Tool for Patient Safety Improvement in Hospitals With Limited Resources. J Patient Saf 2021; 17:e653-e664. [PMID: 29166298 DOI: 10.1097/pts.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the sensitivity and resource efficiency of a partially automated adverse event (AE) surveillance system for routine patient safety efforts in hospitals with limited resources. METHODS Twenty-eight automated triggers from the hospital information system's clinical and administrative databases identified cases that were then filtered by exclusion criteria per trigger and then reviewed by an interdisciplinary team. The system, developed and implemented using in-house resources, was applied for 45 days of surveillance, for all hospital inpatient admissions (N = 1107). Each trigger was evaluated for its positive predictive value (PPV). Furthermore, the sensitivity of the surveillance system (overall and by AE category) was estimated relative to incidence ranges in the literature. RESULTS The surveillance system identified a total of 123 AEs among 283 reviewed medical records, yielding an overall PPV of 52%. The tool showed variable levels of sensitivity across and within AE categories when compared with the literature, with a relatively low overall sensitivity estimated between 21% and 44%. Adverse events were detected in 23 of the 36 AE categories defined by an established harm classification system. Furthermore, none of the detected AEs were voluntarily reported. CONCLUSIONS The surveillance system showed variable sensitivity levels across a broad range of AE categories with an acceptable PPV, overcoming certain limitations associated with other harm detection methods. The number of cases captured was substantial, and none had been previously detected or voluntarily reported. For hospitals with limited resources, this methodology provides valuable safety information from which interventions for quality improvement can be formulated.
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Affiliation(s)
| | - Alain Tanios
- Emergency Department, Lebanese Hospital Geitaoui-University Medical Center, Beirut, Lebanon
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232
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Acheson LS, Siefried KJ, Clifford B, Murray E, Steele M, Clague L, Malone V, Roberts DM, Ferguson LJ, Matthews GV, Ezard N. One-third of people who inject drugs are at risk of incomplete treatment for Staphylococcus aureus bacteraemia: a retrospective medical record review. Int J Infect Dis 2021; 112:63-65. [PMID: 34520844 DOI: 10.1016/j.ijid.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus aureus bacteraemia (SAB) is often a complication of injecting drug use, and is associated with high morbidity and mortality. This article reports the first audit of inpatient parenteral treatment of SAB completion among people who inject drugs (PWID) in Australia. Of 198 patients admitted with SAB, 106 were analysed. Twelve PWID had an inpatient stay <14 days compared with seven non-PWID (34% vs 10%; P=0.002). Sixteen PWID experienced discharge against medical advice compared with zero non-PWID (46% vs 0%; P<0.001). Re-admission to hospital within 28 days was 2.5 times greater among PWID than non-PWID (31% vs 15%; P=0.026). Methadone dose <60 mg/day was associated with premature discharge in opioid-dependent PWID receiving methadone (n=21, 100% vs 31%; P=0.012).
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Affiliation(s)
- Liam S Acheson
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
| | - Krista J Siefried
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Brendan Clifford
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of Sydney, Camperdown, NSW, Australia
| | - Emily Murray
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of Notre Dame, Sydney, Australia
| | - Maureen Steele
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Liesa Clague
- University of Newcastle, Callaghan, NSW, Australia
| | | | - Darren M Roberts
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | | | - Gail V Matthews
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Nadine Ezard
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; National Centre for Clinical Research on Emerging Drugs, UNSW Sydney, NSW, Australia
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Li L, Zhang Z, Hu Y. Neuron - specific enolase predicts the prognosis in advanced small cell lung cancer patients treated with first-line PD-1/PD-L1 inhibitors. Medicine (Baltimore) 2021; 100:e27029. [PMID: 34516493 PMCID: PMC8428697 DOI: 10.1097/md.0000000000027029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/08/2021] [Indexed: 12/03/2022] Open
Abstract
There has been no effective biomarker for small cell lung cancer (SCLC) patients with first-line immune checkpoint inhibitors (ICIs) treatment. The predictive value of neuron-specific enolase (NSE) in this cohort remains unclear.The medical records of 254 consecutive SCLC patients receiving programmed cell death receptor-1/programmed cell death-ligand 1 (PD-1/PD-L1) inhibitors were compiled from January 2015 to October 2020 in Chinese PLA General Hospital. Survival analysis was performed to explore the prognostic role of NSE at baseline and 3 weeks post treatment.One hundred two advanced SCLC patients treated with first-line PD-1/PD-L1 inhibitors were enrolled in this study. Normal baseline NSE levels were correlated with significantly prolonged progression-free survival (PFS, median: 8.7 vs 4.7 months, P = .006) and overall survival (OS, median: 23.8 vs 15.2 months, P = .014) compared with elevated baseline NSE levels, so as for normal NSE levels at 3 weeks with prolonged PFS (median PFS: 8.4 vs 4.5 months, P = .0002) and OS (median OS: 23.3 vs 7.4 months, P < .0001). Intriguingly, elevated NSE levels at 3 weeks were associated with shorter PFS (median PFS: 4.5 vs 5.8 months, P = .04) and OS (median OS: 5.5 vs 14.7 months, P < .0001) compared with normal NSE levels in the elevated baseline NSE subgroup. Most subgroup analyses stratified by clinical characteristics confirmed the prognostic value of baseline NSE level.Elevated NSE levels at baseline and 3 weeks were associated with worse prognosis in advanced SCLC patients receiving first-line ICIs treatment. NSE level might be applied as a useful prognostic tool for SCLC patients with immunotherapy.
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Affiliation(s)
- Lingling Li
- School of Medicine, Nankai University, Tianjin, China
- Department of Oncology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhibo Zhang
- Department of Cardiothoracic Surgery, the 78th Group Army Hospital of Chinese PLA, Mudanjiang, China
| | - Yi Hu
- School of Medicine, Nankai University, Tianjin, China
- Department of Oncology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Boehmer TK, Kompaniyets L, Lavery AM, Hsu J, Ko JY, Yusuf H, Romano SD, Gundlapalli AV, Oster ME, Harris AM. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data - United States, March 2020-January 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1228-1232. [PMID: 34473684 PMCID: PMC8422872 DOI: 10.15585/mmwr.mm7035e5] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Pilli T, Dalmazio G, Porcelli B, Cantara S, Tabucchi A, Pini A, Spreafico A, Cartocci A, Forleo R, Pacini F, Scapellato C, Castagna MG. Screening of Organ-Specific Autoantibodies in a Large Cohort of Patients with Autoimmune Thyroid Diseases. Thyroid 2021; 31:1416-1423. [PMID: 34281356 DOI: 10.1089/thy.2021.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Autoimmune diseases tend to cluster in the same individual or in families. Four types of autoimmune polyglandular syndromes (APS) have been described based on the combination of endocrine and/or non-endocrine autoimmune diseases. In particular, type-3 APS is defined by the association of an autoimmune thyroid disease (ATD) and other autoimmune diseases and has a multifactorial etiology. The natural history of autoimmune diseases is characterized by three stages: potential, subclinical, and clinical. Methods: To determine the prevalence of organ-specific autoantibodies (anti-adrenal, anti-ovary [StCA], anti-pituitary [APA], anti-parietal cells [PCA], anti-tissue transglutaminase [tTGAb], anti-mitochondrial [AMA], anti-glutamic acid decarboxylase [GADA], anti-nicotinic acetylcholine receptor) in patients with ATD and to define the stage of the disease in patients with positive autoantibodies. From January 2016 to November 2018, 1502 patients (1302 female; age 52.7 ± 14.7 [mean ± standard deviation] years, range 18-86 years) with ATD (1285/1502 [85.6%] with chronic autoimmune thyroiditis and 217/1502 [14.4%] with Graves' disease) were prospectively enrolled. Results: The most common organ-specific autoantibodies were PCA (6.99%) and GADA (2.83%), while the prevalence of the remaining autoantibodies was ≤1%. All autoimmune diseases, but celiac disease, were predominant at the potential stage. Sex, ATD type, smoking habit, and coexistence of other autoimmune diseases correlated with the susceptibility to develop chronic atrophic gastritis (CAG) or autoimmune diabetes mellitus. Conclusions: The association between ATD and CAG was the most common manifestation of type-3 APS, mainly at the potential stage, that could lead to appropriate follow-up for early detection and timely treatment of the disease.
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Affiliation(s)
- Tania Pilli
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
| | - Gilda Dalmazio
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
| | - Brunetta Porcelli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Silvia Cantara
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
| | - Antonella Tabucchi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Pini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Adriano Spreafico
- Department of Innovation, Experimentation, Clinical and Translational Research, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Cartocci
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Raffaella Forleo
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
| | - Furio Pacini
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
| | - Carlo Scapellato
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Grazia Castagna
- Department of Clinical, Surgical and Neurological Sciences and University of Siena, Siena, Italy
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LaGrant B, Goldenholz DM, Braun M, Moss RE, Grinspan ZM. Patterns of Recording Epileptic Spasms in an Electronic Seizure Diary Compared With Video-EEG and Historical Cohorts. Pediatr Neurol 2021; 122:27-34. [PMID: 34293636 PMCID: PMC10164279 DOI: 10.1016/j.pediatrneurol.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Use of electronic seizure diaries (e-diaries) by caregivers of children with epileptic spasms is not well understood. We describe the demographic and seizure-related information of children with epileptic spasms captured in a widely used e-diary and explore the potential biases in how caregivers report these data. METHODS We analyzed children with epileptic spasms in an e-diary, Seizure Tracker, from 2007 to 2018. We described variables including sex, time of seizure, percentage of spasms occurring as individual spasms (versus in clusters), cluster duration, and number of spasms per cluster. We compared seizure characteristics in the e-diary cohort with published cohorts to identify biases in caregiver-reported epileptic spasms. We also reviewed seizure patterns in a small cohort of children with epileptic spasms monitored on overnight video-electroencephalography (vEEG). RESULTS There were 314 children in the e-diary cohort and nine children in the vEEG cohort. The e-diary cohort was more likely than expected to report counts divisible by five. The e-diary cohort had a lower proportion of nighttime spasms than expected based on data from published cohorts. The e-diary cohort had a significantly lower percentage of spasms as individual spasms, a greater number of spasms per cluster, and a greater cluster duration relative to the vEEG cohort. CONCLUSIONS Caregivers using e-diaries for epileptic spasms may miss individual spams, be more likely to report long clusters, round counts to the nearest five, and underreport nighttime spasms. Clinicians should be aware of these reporting biases when using e-diary data to guide care for children with epileptic spasms.
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Affiliation(s)
- Brian LaGrant
- MD Program, Weill Cornell Medicine, New York, New York
| | - Daniel M Goldenholz
- Division of Epilepsy, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marvin Braun
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | | | - Zachary M Grinspan
- MD Program, Weill Cornell Medicine, New York, New York; Department of Pediatrics, Weill Cornell Medicine, New York, New York; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
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Bødker B, Hvidman L, Weber T, Møller M, Andersen BR, Westergaard HB, Rosthøj S, Sørensen JL. Reduction in maternal mortality in Denmark over three decades. Dan Med J 2021; 68:A02210143. [PMID: 34477097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Women very rarely die during pregnancy and childbirth in Denmark. Although maternal deaths are registered worldwide, various studies indicate that underreporting does occur. This paper presents validated Danish register data for two periods between 1985 and 2017. METHODS Maternal deaths were identified from 1985 to 1994 and from 2002 to 2017 by linking four national health registers, death certificates and notifications from maternity wards. A group of obstetricians categorised and assessed all medical records, classifying each case by cause of death. RESULTS Linkage of four registers yielded valid data, leading to the identification of 143 maternal deaths in the abovementioned periods. From 1985-1994 there were 73 deaths and 618,021 live births, resulting in a maternal mortality rate of 11.8 per 100,000 live births with a non-significant 2% annual increase (95% confidence interval (CI): -6.0-11.0%). From 2002 to 2017 there were 70 maternal deaths and 999,206 live births, resulting in a maternal mortality rate of 7.0 per 100,000 live births (95% CI: 5.5-8.9) with a significant 9% annual decrease (95% CI: 4.0-14.0%). CONCLUSIONS Overall maternal mortality decreased in the course of the two periods (n = 33 years), with a significant decrease during the last period. This is suggested to be a result of multiple clinical and organisational improvements as discussed in the paper. FUNDING none. TRIAL REGISTRATION not relevant.
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238
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Pillay L, Govender R, Pillay S. Doctor-perceived-barriers to telephone clinics at KwaZulu-Natal hospitals during the COVID-19 pandemic. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34476964 PMCID: PMC8424715 DOI: 10.4102/safp.v63i1.5334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.
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Affiliation(s)
- Lushen Pillay
- Department of Gastroenterology, Princess Alexandra Hospital, Harlow.
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239
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Ma S, Jia W, Hou G, Quan P, Zhang L, Fan X, Yang B, Su X, Jiao J, Wang F, Yuan J, Qin W, Yang X. Case reports of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy: A retrospective analysis. Medicine (Baltimore) 2021; 100:e26886. [PMID: 34414942 PMCID: PMC8376354 DOI: 10.1097/md.0000000000026886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.
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Affiliation(s)
- Shuaijun Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijing Jia
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Penghe Quan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Longlong Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaozheng Fan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Bo Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xing Su
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianhua Jiao
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Xiaojian Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Abstract
BACKGROUND Medical autopsies are rarely made subject to quality assurance. We have investigated the quality of autopsy reports in Norway and assessed the impact of errors on the cause of death statistics. MATERIAL AND METHOD Every fifth medical autopsy report for adults (> 2 years) in 2014 was reviewed. The significance of the autopsy result for the registration of cause of death was studied by comparing the death certificate issued by the clinician with the coding in the Cause of Death Registry after the autopsy. RESULTS A total of 389 autopsy reports from 15 departments of pathology were reviewed. The autopsy request, as well as the death certificate and the codes for the cause of death from the Cause of Death Registry were available for 339 and 360 cases respectively. Ninety-five requests had specified clinical questions, but were commented on by the pathologist in 33 cases. Obesity was rarely reported as a finding, even in cases of pathological deviations from a normal weight. A post-mortem virus examination or toxicology had been performed in 1 and 28 autopsies respectively. The average turnaround time for autopsies without and with a neuropathological examination was 99 and 138 days respectively. Errors in reporting the cause of death or inadequate reporting were evident in 69 cases (18 %), most frequently for deaths from cardiovascular diseases. The autopsy result led to a change to the cause of death in the Cause of Death Registry in 206 out of 360 (57 %) cases for which coding data were available. Errors in the formulation of the autopsy result resulted in erroneous coding of the cause of death in 22 out of 47 (47 %) of cases with errors. INTERPRETATION The proportion of autopsy reports with errors in the formulation of the cause of death was unexpectedly high and may have consequences for the cause of death statistics. Long turnaround times for autopsies complicate communication with the clinician about the findings.
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241
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Hwang SH, Ah YM, Jun KH, Jung JW, Kang MG, Park HK, Lee EK, Park HK, Chung JE, Kim SH, Lee JY. Development and Validation of a Trigger Tool for Identifying Drug-Related Emergency Department Visits. Int J Environ Res Public Health 2021; 18:ijerph18168572. [PMID: 34444320 PMCID: PMC8391800 DOI: 10.3390/ijerph18168572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
There are various trigger tools for detecting adverse drug events (ADEs), however, a drug-related emergency department (ED) visit trigger tool (DrEDTT) has not yet been developed. We aimed to develop and validate a DrEDTT with a multi-center cohort. In this cross-sectional study, we developed the DrEDTT consisting of 28 triggers through a comprehensive literature review and three phase expert group discussion. Next, we evaluated the performance of the DrEDTT by applying it to relevant medical records retrieved from four hospitals from January 2016 to June 2016. Two experts performed an in-depth chart review of a 25% of random sample of trigger flagged and unflagged ED visits and a true ADE was determined through causality assessment. Among 66,564 patients who visited the ED for reasons other than traffic accident and trauma during the study period, at least one trigger was found in 21,268 (32.0%) patients. A total of 959 true ADE cases (5.8%) were identified from a randomly selected 25% of ED visit cases. The overall positive predictive value was 14.0% (range: 8.3-66.7%). Sensitivity and specificity of DrEDTT were 77.7% and 70.4%, respectively. In conclusion, this newly developed trigger tool might be helpful to detect ADE-related ED visits.
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Affiliation(s)
- Sung-Hee Hwang
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Korea; (S.-H.H.); (J.-E.C.)
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea;
| | - Kwang-Hee Jun
- Institute of Pharmaceutical Sciences, College of Pharmacy and Research, Seoul National University, Seoul 08826, Korea;
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea;
| | - Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea;
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University College of Medicine, Busan 50612, Korea;
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (E.-K.L.); (H.-K.P.)
| | - Hye-Kyung Park
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (E.-K.L.); (H.-K.P.)
| | - Jee-Eun Chung
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Korea; (S.-H.H.); (J.-E.C.)
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
- Correspondence: (S.-H.K.); (J.-Y.L.); Tel.: +82-2-2290-8336 (S.-H.K.); +82-2-3668-7472 (J.-Y.L.)
| | - Ju-Yeun Lee
- Institute of Pharmaceutical Sciences, College of Pharmacy and Research, Seoul National University, Seoul 08826, Korea;
- Correspondence: (S.-H.K.); (J.-Y.L.); Tel.: +82-2-2290-8336 (S.-H.K.); +82-2-3668-7472 (J.-Y.L.)
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242
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Affiliation(s)
- Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
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243
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Suls J, Bayliss EA, Berry J, Bierman AS, Chrischilles EA, Farhat T, Fortin M, Koroukian SM, Quinones A, Silber JH, Ward BW, Wei M, Young-Hyman D, Klabunde CN. Measuring Multimorbidity: Selecting the Right Instrument for the Purpose and the Data Source. Med Care 2021; 59:743-756. [PMID: 33974576 PMCID: PMC8263466 DOI: 10.1097/mlr.0000000000001566] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adults have a higher prevalence of multimorbidity-or having multiple chronic health conditions-than having a single condition in isolation. Researchers, health care providers, and health policymakers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures. OBJECTIVE The objective of this study was to describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures. DESIGN Instruments were reviewed and guidance developed during a special expert workshop sponsored by the National Institutes of Health on September 25-26, 2018. RESULTS Workshop participants identified 4 common purposes for multimorbidity measurement as well as the advantages and disadvantages of 5 major data sources: medical records/clinical assessments, administrative claims, public health surveys, patient reports, and electronic health records. Participants surveyed 15 instruments and 2 public health data systems and described characteristics of the measures, validity, and other features that inform tool selection. Guidance on instrument selection includes recommendations to match the purpose of multimorbidity measurement to the measurement approach and instrument, review available data sources, and consider contextual and other related constructs to enhance the overall measurement of multimorbidity. CONCLUSIONS The accuracy of multimorbidity measurement can be enhanced with appropriate measurement selection, combining data sources and special considerations for fully capturing multimorbidity burden in underrepresented racial/ethnic populations, children, individuals with multiple Adverse Childhood Events and older adults experiencing functional limitations, and other geriatric syndromes. The increased availability of comprehensive electronic health record systems offers new opportunities not available through other data sources.
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Affiliation(s)
- Jerry Suls
- Behavioral Research Program, National Cancer Institute, Bethesda, MD
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jay Berry
- Complex Care Services, Division of General Pediatrics, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD
| | | | - Tilda Farhat
- Office of Science Policy, Strategic Planning, Reporting, and Data, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Chicoutimi, Quebec, QC, Canada
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Ana Quinones
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Jeffrey H Silber
- Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian W Ward
- Division of Health Care Statistics, National Center for Health Statistics, Hyattsville, MD
| | - Melissa Wei
- Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences Research, National Institutes of Health
| | - Carrie N Klabunde
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD
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244
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Khan A, Shang N, Petukhova L, Zhang J, Shen Y, Hebbring SJ, Moncrieffe H, Kottyan LC, Namjou-Khales B, Knevel R, Raychaudhuri S, Karlson EW, Harley JB, Stanaway IB, Crosslin D, Denny JC, Elkind MS, Gharavi AG, Hripcsak G, Weng C, Kiryluk K. Medical Records-Based Genetic Studies of the Complement System. J Am Soc Nephrol 2021; 32:2031-2047. [PMID: 33941608 PMCID: PMC8455263 DOI: 10.1681/asn.2020091371] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Genetic variants in complement genes have been associated with a wide range of human disease states, but well-powered genetic association studies of complement activation have not been performed in large multiethnic cohorts. METHODS We performed medical records-based genome-wide and phenome-wide association studies for plasma C3 and C4 levels among participants of the Electronic Medical Records and Genomics (eMERGE) network. RESULTS In a GWAS for C3 levels in 3949 individuals, we detected two genome-wide significant loci: chr.1q31.3 (CFH locus; rs3753396-A; β=0.20; 95% CI, 0.14 to 0.25; P=1.52x10-11) and chr.19p13.3 (C3 locus; rs11569470-G; β=0.19; 95% CI, 0.13 to 0.24; P=1.29x10-8). These two loci explained approximately 2% of variance in C3 levels. GWAS for C4 levels involved 3998 individuals and revealed a genome-wide significant locus at chr.6p21.32 (C4 locus; rs3135353-C; β=0.40; 95% CI, 0.34 to 0.45; P=4.58x10-35). This locus explained approximately 13% of variance in C4 levels. The multiallelic copy number variant analysis defined two structural genomic C4 variants with large effect on blood C4 levels: C4-BS (β=-0.36; 95% CI, -0.42 to -0.30; P=2.98x10-22) and C4-AL-BS (β=0.25; 95% CI, 0.21 to 0.29; P=8.11x10-23). Overall, C4 levels were strongly correlated with copy numbers of C4A and C4B genes. In comprehensive phenome-wide association studies involving 102,138 eMERGE participants, we cataloged a full spectrum of autoimmune, cardiometabolic, and kidney diseases genetically related to systemic complement activation. CONCLUSIONS We discovered genetic determinants of plasma C3 and C4 levels using eMERGE genomic data linked to electronic medical records. Genetic variants regulating C3 and C4 levels have large effects and multiple clinical correlations across the spectrum of complement-related diseases in humans.
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Affiliation(s)
- Atlas Khan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ning Shang
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lynn Petukhova
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jun Zhang
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Yufeng Shen
- Department of Systems Biology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Scott J. Hebbring
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Halima Moncrieffe
- Department of Pediatrics, Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Leah C. Kottyan
- Department of Pediatrics, Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Bahram Namjou-Khales
- Department of Pediatrics, Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Soumya Raychaudhuri
- Center for Data Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Genetics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts
- Centre for Genetics and Genomics Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Elizabeth W. Karlson
- Division of Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - John B. Harley
- Department of Pediatrics, Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Ian B. Stanaway
- Department of Biomedical Informatics Medical Education, School of Medicine, University of Washington, Seattle, Washington
| | - David Crosslin
- Department of Biomedical Informatics Medical Education, School of Medicine, University of Washington, Seattle, Washington
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Mitchell S.V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ali G. Gharavi
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - George Hripcsak
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Chunhua Weng
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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245
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Winchester DE, Shaw LJ. The importance of the patient's voice in nuclear cardiology. J Nucl Cardiol 2021; 28:1519-1521. [PMID: 31650492 DOI: 10.1007/s12350-019-01918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Affiliation(s)
- David E Winchester
- Malcom Randall VAMC, 1601 SW Archer Rd 111-D, Gainesville, FL, 32608, USA.
| | - Leslee J Shaw
- Department of Radiology, Weill Cornell Medicine, New York, USA
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246
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Zhang X. [Corrigendum for the completion date of Zhanshan Medical Records]. Zhonghua Yi Shi Za Zhi 2021; 51:217-219. [PMID: 34645119 DOI: 10.3760/cma.j.cn112155-20200717-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ren Zhanshan, the author of Zhanshan Medical Records published in 1924. The date of his birth was unknown or incorrect according to the local chronicles of the Qing Dynasty and a variety of modern bibliographic and medical books. The time, when Zhanshan Medical Records was completed, was not clearly recorded or was claimed in Bingchen (1736), to be dated the first year of QianLong in the Qing dynasty. Based on the genealogy collected by descendants of the Ren family, it was found that he was born in the fifteenth year of Qianlong (1751) and died in the eighth year of Daoguang (1828). Additionally, according to the date of his medical experience recorded in the preface of the Zhanshan Medical Records, the writing date of this book was roughly between 1814 and 1823.
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Affiliation(s)
- X Zhang
- The School of Basic Medicine, Zhejiang Chinese Medicine University, Hangzhou 310051, China
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247
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Teyateeti P, Ungtrakul T. Retrospective review of cutaneous metastasis among 11,418 patients with solid malignancy: A tertiary cancer center experience. Medicine (Baltimore) 2021; 100:e26737. [PMID: 34398051 PMCID: PMC8294925 DOI: 10.1097/md.0000000000026737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Cutaneous metastasis (CM) occurs infrequently and usually presents during the later stages of cancer, and has a poor prognosis. Although there are insufficient current data, cancer treatment changes could have a positive impact on the outcome. This retrospective study aimed to review the pattern and prognosis of CM in patients with solid malignancy in a tertiary cancer center in Thailand.We reviewed the medical records of cancer patients diagnosed with CM between October 2009 and August 2015 at Chulabhorn Hospital, a tertiary cancer center in Thailand. Patients with primary skin cancer and hematological malignancies were excluded. We collected and analyzed data, including the time of cancer diagnosis and CM, type of cancer, clinical characteristics, and survival outcome.Of 11,418 patients, there were 33 (0.3%) were diagnosed with CM. Breast cancer was the most common primary cancer (12 cases, 36%). Skin nodules were commonly detected on the anterior chest wall. Also, 79% of CM patients had concomitant visceral metastasis. The median overall survival of those with CM was 9.21 months (95% confidence interval 4.75-83.38 months) regardless of presentation either at onset or disease recurrence (P = .083). However, the change of management was affected in 78% diagnosed with a later stage of CM. No statistical difference in survival was observed between breast cancer and non-breast cancer patients (8.79 vs 9.21 months, P = .613).Despite CM being a sign of poor prognosis, it may still be an indicator for changing cancer patients' treatment. Hence, early CM diagnosis and prompt novel therapy may positively affect outcomes for cancer patients.
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Affiliation(s)
- Phurichaya Teyateeti
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Sul YH, Lee JY, Kim SH, Ye JB, Lee JS, Yoon SY, Choi JH. Risk factors for acute kidney injury in critically ill patients with torso injury: A retrospective observational single-center study. Medicine (Baltimore) 2021; 100:e26723. [PMID: 34398045 PMCID: PMC8294861 DOI: 10.1097/md.0000000000026723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/06/2021] [Indexed: 01/04/2023] Open
Abstract
Acute kidney injury (AKI) is common in trauma patients and associated with poor outcomes. Identifying AKI risk factors in trauma patients is important for risk stratification and provision of optimal intensive care unit (ICU) treatment. This study identified AKI risk factors in patients admitted to critical care after sustaining torso injuries.We performed a retrospective chart review involving 380 patients who sustained torso injuries from January 2016 to December 2019. Patients were included if they were aged >15 years, admitted to an ICU, survived for >48 hours, and had thoracic and/or abdominal injuries and no end-stage renal disease. AKI was defined according to the Kidney Disease Improving Global Outcomes definition and staging system. Clinical and laboratory variables were compared between the AKI and non-AKI groups (n = 72 and 308, respectively). AKI risk factors were assessed using multivariate logistic regression analysis.AKI occurred in 72 (18.9%) patients and was associated with higher mortality than non-AKI patients (26% vs 4%, P < .001). Multivariate logistic regression analysis identified bowel injury, cumulative fluid balance >2.5 L for 24 hours, lactate levels, and vasopressor use (adjusted odds ratio: 2.953, 2.058, 1.170, and 2.910; 95% confidence interval: 1.410-6.181, 1.017-4.164, 1.019-1.343, and 1.414-5.987; P = .004, .045, .026, and .004, respectively) as independent risk factors for AKI.AKI in patients admitted to the ICU with torso injury had a substantial mortality. Recognizing risk factors at an early stage could aid risk stratification and provision of optimal ICU care.
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Affiliation(s)
- Young Hoon Sul
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jin Young Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Se Heon Kim
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Bong Ye
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Suk Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Su Young Yoon
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Shang W, Hu H, Shen M, Wu J, Yu Z, Xuan L. Investigating the correlation between serum albumin level and the prognosis of Bell's palsy. Medicine (Baltimore) 2021; 100:e26726. [PMID: 34398047 PMCID: PMC8294884 DOI: 10.1097/md.0000000000026726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/08/2021] [Indexed: 01/16/2023] Open
Abstract
To investigate the correlation between the serum albumin level and the prognosis of patients with Bell's palsy.We retrospectively analyzed the clinical records of 311 inpatients with Bell's palsy (BP) in our hospital between September 2018 and October 2019. The patients were divided into 2 groups: the recovered group (with the House-Brackmann grade ≤ 2) and the unrecovered group (with the House-Brackmann grade > 2), according to the follow-up results within 3 months after discharge. Blood test indicators (white blood cell count, neutrophil-to-lymphocyte ratio, red cell distribution width, serum albumin level, globulin level) and basic clinical data (age, sex, course of the disease, inpatient days, comorbidity of hypertension, diabetes, and hepatitis B) of the 2 groups were compared to explore whether they were correlated with the prognosis of patients with Bell's palsy.The serum albumin level of patients with BP in the unrecovered group was significantly lower than that of the recovered group (medians [interquartile range], 40.75 [38.40, 43.85] vs 44 [42.10, 46.20], P < .001). Multivariate binary logistic regression revealed that serum albumin (odds ratio 0.772, 95% confidence interval 0.711-0.839, P < .001) was a protective factor for BP prognosis.Serum albumin is a protective factor for the prognosis of BP. Although more prospective clinical controlled trials are needed, our study provides valuable and crucial prognostic information for physicians.
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Affiliation(s)
- Wenfang Shang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haiyu Hu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengxia Shen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiangxia Wu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zelin Yu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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250
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Callahan A, Polony V, Posada JD, Banda JM, Gombar S, Shah NH. ACE: the Advanced Cohort Engine for searching longitudinal patient records. J Am Med Inform Assoc 2021; 28:1468-1479. [PMID: 33712854 PMCID: PMC8279796 DOI: 10.1093/jamia/ocab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To propose a paradigm for a scalable time-aware clinical data search, and to describe the design, implementation and use of a search engine realizing this paradigm. MATERIALS AND METHODS The Advanced Cohort Engine (ACE) uses a temporal query language and in-memory datastore of patient objects to provide a fast, scalable, and expressive time-aware search. ACE accepts data in the Observational Medicine Outcomes Partnership Common Data Model, and is configurable to balance performance with compute cost. ACE's temporal query language supports automatic query expansion using clinical knowledge graphs. The ACE API can be used with R, Python, Java, HTTP, and a Web UI. RESULTS ACE offers an expressive query language for complex temporal search across many clinical data types with multiple output options. ACE enables electronic phenotyping and cohort-building with subsecond response times in searching the data of millions of patients for a variety of use cases. DISCUSSION ACE enables fast, time-aware search using a patient object-centric datastore, thereby overcoming many technical and design shortcomings of relational algebra-based querying. Integrating electronic phenotype development with cohort-building enables a variety of high-value uses for a learning health system. Tradeoffs include the need to learn a new query language and the technical setup burden. CONCLUSION ACE is a tool that combines a unique query language for time-aware search of longitudinal patient records with a patient object datastore for rapid electronic phenotyping, cohort extraction, and exploratory data analyses.
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Affiliation(s)
- Alison Callahan
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Vladimir Polony
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - José D Posada
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, Georgia, USA
| | - Saurabh Gombar
- Department of Pathology, School of Medicine, Stanford University, Stanford, California, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, School of Medicine, School of Medicine, Stanford University, Stanford, California, USA
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