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Shin S, Kowahl N, Hansen T, Ling AY, Barman P, Cauwenberghs N, Rainaldi E, Short S, Dunn J, Shandhi MMH, Shah SH, Mahaffey KW, Kuznetsova T, Daubert MA, Douglas PS, Haddad F, Kapur R. Real-world walking behaviors are associated with early-stage heart failure: a Project Baseline Health Study. J Card Fail 2024:S1071-9164(24)00113-1. [PMID: 38582256 DOI: 10.1016/j.cardfail.2024.02.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Data collected via wearables may complement in-clinic assessments to monitor subclinical heart failure (HF). OBJECTIVES Evaluate the association of sensor-based digital walking measures with HF stage and characterize their correlation with in-clinic measures of physical performance, cardiac function and participant reported outcomes (PROs) in individuals with early HF. METHODS The analyzable cohort included participants from the Project Baseline Health Study (PBHS) with HF stage 0, A, or B, or adaptive remodeling phenotype (without risk factors but with mild echocardiographic change, termed RF-/ECHO+) (based on available first-visit in-clinic test and echocardiogram results) and with sufficient sensor data. We computed daily values per participant for 18 digital walking measures, comparing HF subgroups vs stage 0 using multinomial logistic regression and characterizing associations with in-clinic measures and PROs with Spearman's correlation coefficients, adjusting all analyses for confounders. RESULTS In the analyzable cohort (N=1265; 50.6% of the PBHS cohort), one standard deviation decreases in 17/18 walking measures were associated with greater likelihood for stage-B HF (multivariable-adjusted odds ratios [ORs] vs stage 0 ranging from 1.18-2.10), or A (ORs vs stage 0, 1.07-1.45), and lower likelihood for RF-/ECHO+ (ORs vs stage 0, 0.80-0.93). Peak 30-minute pace demonstrated the strongest associations with stage B (OR vs stage 0=2.10; 95% CI:1.74-2.53) and A (OR vs stage 0=1.43; 95% CI:1.23-1.66). Decreases in 13/18 measures were associated with greater likelihood for stage-B HF vs stage A. Strength of correlation with physical performance tests, echocardiographic cardiac-remodeling and dysfunction indices and PROs was greatest in stage B, then A, and lowest for 0. CONCLUSIONS Digital measures of walking captured by wearable sensors could complement clinic-based testing to identify and monitor pre-symptomatic HF.
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Affiliation(s)
| | | | | | | | | | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Sarah Short
- Verily Life Sciences; South San Francisco, CA
| | - Jessilyn Dunn
- Duke University Department of Biomedical Engineering; Durham, NC; Duke University Department of Biostatistics & Bioinformatics; Durham, NC; Duke Clinical Research Institute; Durham, NC
| | - Md Mobashir Hasan Shandhi
- Duke Clinical Research Institute; Durham, NC; Division of Cardiology, Duke University Medical School; Duke University; Durham, NC
| | - Svati H Shah
- Duke Clinical Research Institute; Durham, NC; Division of Cardiology, Duke University Medical School; Duke University; Durham, NC
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford School of Medicine; Stanford, CA
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Melissa A Daubert
- Duke Clinical Research Institute; Durham, NC; Division of Cardiology, Duke University Medical School; Duke University; Durham, NC
| | - Pamela S Douglas
- Duke Clinical Research Institute; Durham, NC; Division of Cardiology, Duke University Medical School; Duke University; Durham, NC
| | - Francois Haddad
- Stanford Center for Clinical Research, Department of Medicine, Stanford School of Medicine; Stanford, CA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University; Stanford, CA; Stanford Cardiovascular Institute, Stanford University; Stanford, CA
| | - Ritu Kapur
- Verily Life Sciences; South San Francisco, CA; Department of Neurology, Radboud University Medical Center; Nijmegen, The Netherlands
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Ling AY, Montez-Rath ME, Carita P, Chandross KJ, Lucats L, Meng Z, Sebastien B, Kapphahn K, Desai M. An Overview of Current Methods for Real-World Applications to Generalize or Transport Clinical Trial Findings to Target Populations of Interest. Epidemiology 2023:00001648-990000000-00144. [PMID: 37255252 PMCID: PMC10392887 DOI: 10.1097/ede.0000000000001633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
It has been well established that randomized clinical trials have poor external validity, resulting in findings that may not apply to relevant - or target - populations. When the trial is sampled from the target population, generalizability methods have been proposed to address the applicability of trial findings to target populations. When the trial sample and target populations are distinct, transportability methods may be applied for this purpose. However, generalizability and transportability studies present challenges, particularly around the strength of their conclusions. We review and summarize state-of-the-art methods for translating trial findings to target populations. We additionally provide a novel step-by-step guide to address these challenges, illustrating principles through a published case study. When conducted with rigor, generalizability and transportability studies can play an integral role in regulatory decisions by providing key real-world evidence.
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Affiliation(s)
- Albee Y Ling
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304
| | | | | | | | | | | | - Kris Kapphahn
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304
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Saxena MR, Ling AY, Carrillo E, Alvarez A, Yiadom MYAB, Bennett CL, Gallegos M. Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021. J Grad Med Educ 2023; 15:175-179. [PMID: 37139207 PMCID: PMC10150826 DOI: 10.4300/jgme-d-22-00384.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/16/2022] [Accepted: 02/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs. Objective To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States. Methods We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time. Results Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males. Conclusions Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.
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Affiliation(s)
- Monica Rakesh Saxena
- All authors are with the Stanford School of Medicine
- Monica Rakesh Saxena, MD, JD, is an Assistant Professor, Department of Emergency Medicine
| | - Albee Y. Ling
- All authors are with the Stanford School of Medicine
- Albee Y. Ling, PhD, is a Biostatistician, Quantitative Sciences Unit
| | - Eli Carrillo
- All authors are with the Stanford School of Medicine
- Eli Carrillo, MD, is an Assistant Professor, Department of Emergency Medicine
| | - Al'ai Alvarez
- All authors are with the Stanford School of Medicine
- Al'ai Alvarez, MD, is an Associate Professor, Department of Emergency Medicine
| | - Maame Yaa A. B. Yiadom
- All authors are with the Stanford School of Medicine
- Maame Yaa A. B. Yiadom, MD, MPH, MSCI, is an Associate Professor, Department of Emergency Medicine
| | - Christopher L. Bennett
- All authors are with the Stanford School of Medicine
- Christopher L. Bennett, MD, MA, is an Assistant Professor, Department of Emergency Medicine
| | - Moises Gallegos
- All authors are with the Stanford School of Medicine
- Moises Gallegos, MD, is an Assistant Professor, Department of Emergency Medicine
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Ling AY, Jreich R, Montez-Rath ME, Meng Z, Kapphahn K, Chandross KJ, Desai M. Transporting observational study results to a target population of interest using inverse odds of participation weighting. PLoS One 2022; 17:e0278842. [PMID: 36520950 PMCID: PMC9754161 DOI: 10.1371/journal.pone.0278842] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Inverse odds of participation weighting (IOPW) has been proposed to transport clinical trial findings to target populations of interest when the distribution of treatment effect modifiers differs between trial and target populations. We set out to apply IOPW to transport results from an observational study to a target population of interest. We demonstrated the feasibility of this idea with a real-world example using a nationwide electronic health record derived de-identified database from Flatiron Health. First, we conducted an observational study that carefully adjusted for confounding to estimate the treatment effect of fulvestrant plus palbociclib relative to letrozole plus palbociclib as a second-line therapy among estrogen receptor (ER)-positive, human epidermal growth factor receptor (HER2)-negative metastatic breast cancer patients. Second, we transported these findings to the broader cohort of patients who were eligible for a first-line therapy. The interpretation of the findings and validity of such studies, however, rely on the extent that causal inference assumptions are met.
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Affiliation(s)
- Albee Y. Ling
- Division of Biomedical Informatics Research, Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Rana Jreich
- Sanofi, Bridgewater, NJ, United States of America
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | | | - Kris Kapphahn
- Division of Biomedical Informatics Research, Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | | | - Manisha Desai
- Division of Biomedical Informatics Research, Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
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Cleveland Manchanda EC, Ling AY, Bottcher JL, Marsh RH, Brown DFM, Bennett CL, Yiadom MYAB. Three decades of demographic trends among academic emergency physicians. J Am Coll Emerg Physicians Open 2022; 3:e12781. [PMID: 35982985 PMCID: PMC9375047 DOI: 10.1002/emp2.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/16/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time. Methods Data from the Association of American Medical Colleges faculty roster (1990–2020) were used to assess the changing demographics of full‐time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups. Results The number of full‐time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03–1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n = 3, 1.40% in 1990 to n = 326, 5.55% in 2020; OR 1.01, 95% CI 1.01–1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31‐year study period (N = 9, 4.21% in 1990 and N = 266, 4.53% in 2020; OR 1.00, 95% CI 0.99–1.00). Conclusions Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.
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Affiliation(s)
- Emily C. Cleveland Manchanda
- Department of Emergency Medicine Boston Medical Center Boston Massachusetts USA
- Boston University School of Medicine Boston Massachusetts USA
| | - Albee Y. Ling
- Quantitative Sciences Unit Stanford University School of Medicine Palo Alto California USA
| | | | - Regan H. Marsh
- Department of Emergency Medicine Brigham and Women's Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - David F. M. Brown
- Harvard Medical School Boston Massachusetts USA
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Christopher L. Bennett
- Department of Emergency Medicine Stanford University School of Medicine Palo Alto California USA
| | - Maame Yaa A. B. Yiadom
- Department of Emergency Medicine Stanford University School of Medicine Palo Alto California USA
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Montez-Rath ME, Lubwama R, Kapphahn K, Ling AY, LoCasale R, Robinson L, Chandross KJ, Desai M. Characterizing real world safety profile of oral Janus kinase inhibitors among adult atopic dermatitis patients: evidence transporting from the rheumatoid arthritis population. Curr Med Res Opin 2022; 38:1431-1437. [PMID: 35699028 DOI: 10.1080/03007995.2022.2088715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To address potential safety concerns of Janus Kinase Inhibitors (JAK-Is), we characterized their safety profile in the atopic dermatitis (AD) patient population. METHODS In this retrospective observational study, we used propensity score-based methods and a Poisson modeling framework to estimate the incidence of health outcomes of interest (HOI) for the AD patient. To that end, two mutually exclusive cohorts were created using a real world data resource: a rheumatoid arthritis (RA) cohort, where we directly quantify the safety risk of JAK-Is on HOIs, and an AD cohort, that comprises the target population of interest and to whom we transport the results obtained from the RA cohort. The RA cohort included all adults who filled at least one prescription for a JAK-I (tofacitinib, baricitinib, or upadacitinib) between 1 January 2017 and 31 January 2020. The AD cohort consisted of all adults diagnosed with AD during the same period. We first estimated the incidence rate of each HOI in the RA cohort, and then transported the results to the AD population. RESULTS The RA and AD cohorts included 5,296 and 261,855 patients, respectively. On average, patients in the AD cohort were younger, more often male, more likely to be Asian, and had higher household income. They also had a lower prevalence of several comorbid conditions including hypertension, chronic kidney disease, obesity, and depression. Overall, the transported incidence rates of the HOIs to the AD cohort were lower than those obtained in the RA cohort by 13-50%. CONCLUSION We applied transportability methods to characterize the risk of the HOIs in the AD population and found absolute risks higher than that of the general population. Future work is needed to validate these conclusions in comparable populations.
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Affiliation(s)
- Maria E Montez-Rath
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Kris Kapphahn
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Albee Y Ling
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Manisha Desai
- Department of Medicine, Division of Biomedical Informatics Research, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA, USA
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Abstract
BACKGROUND An early HIV diagnosis improves patient outcomes, reduces the burden of undiagnosed HIV, and limits transmission. There is a need for an updated assessment of HIV testing rates in the emergency department (ED). SETTING The National Hospital Ambulatory Medical Care Survey sampling ED visits were weighted to give an estimate of ED visits across all US states in 2018. METHODS We analyzed patients aged 13-64 years without known HIV and estimated ED visits with HIV testing and then stratified by race, ethnicity, and region. Descriptive statistics and mapping were used to illustrate and compare patient, visit, and hospital characteristics for visits with HIV testing. RESULTS Of 83.0 million weighted visits to EDs in 2018 by patients aged 13-64 years without a known HIV infection (based on 13,237 National Hospital Ambulatory Medical Care Survey sample visits), HIV testing was performed in 1.05% of visits. HIV testing was more frequent for patients aged 13-34 years compared with that for patients aged 35-64 years (1.32% vs. 0.82%, P = 0.056), Black patients compared with that for White and other patients (1.73% vs. 0.79% and 0.41%, P = 0.002), Hispanic or Latino patients compared with that for non-Hispanic or Latino patients (2.18% vs. 0.84%, P = 0.001), and patients insured by Medicaid compared with that for patients insured by private or other insurance (1.71% vs. 0.64% and 0.96%, P = 0.003). HIV testing rates were the highest in the Northeast (1.72%), followed by the South (1.05%). CONCLUSIONS HIV testing occurred in a minority of ED visits. There are differences in rates of HIV testing by race, ethnicity, and location. Although rates of testing have increased, rates of ED-based HIV testing remain low.
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Affiliation(s)
- Carson E Clay
- New York University Grossman School of Medicine, New York, NY
| | - Albee Y Ling
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA
| | - Christopher L Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA; and
- Department of Epidemiology, Stanford University School of Medicine, Palo Alto, CA
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Bennett CL, Ling AY, Agrawal P, Pierce A, Pasao MA, Ray D, Cleveland Manchanda EC. How we compare: Society for Academic Emergency Medicine faculty membership demographics. AEM Educ Train 2022; 6:S93-S96. [PMID: 35783079 PMCID: PMC9222880 DOI: 10.1002/aet2.10747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Society for Academic Emergency Medicine (SAEM) has a core value to promote a diverse workforce for patients, providers, and learners. Understanding the organization's membership demographics and how that compares to the academic emergency medicine (EM) workforce is prerequisite to the success of this core value. METHODS We obtained 2020 faculty membership data sets from the Association of American Medical Colleges (AAMC) and SAEM; data included self-reported sex, race and ethnicity, and academic rank (professor, associate professor, assistant professor, and instructor). We employed standardized mean difference (SMD) to quantify difference in proportions between data sets. RESULTS We identified 5874 (AAMC) and 2785 (SAEM) faculty. The AAMC (38.3%) and the SAEM (41.3%) had similar proportions of overall female faculty (SMD 0.063) although SAEM (compared to AAMC) had a higher proportion of female full (25.5% vs. 20.5%, SMD 0.121) and assistant (46.5% vs. 41.2%, SMD 0.106) professors. With the exception of Hispanic instructors, SAEM (compared to AAMC) also had higher proportions of Black and Hispanic female faculty at all ranks (SMD ranging from 0.109 to 0.777). CONCLUSION SAEM faculty demographics generally reflect that of the academic EM workforce demographics reported in the AAMC database and that overall, the proportions of female, Black, and Hispanic faculty in SAEM are slightly larger than those in the AAMC database. However, faculty who identify as Black or Hispanic in both the AAMC and the SAEM databases (compared to the overall U.S. population) are dramatically underrepresented.
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Affiliation(s)
| | - Albee Y. Ling
- Quantitative Sciences UnitStanford School of MedicinePalo AltoCaliforniaUSA
| | - Pooja Agrawal
- Department of Emergency MedicineYale UniversityNew HavenConnecticutUSA
| | - Ava Pierce
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Melissa A. Pasao
- Department of Emergency MedicineStanford School of MedicinePalo AltoCaliforniaUSA
| | - Douglas Ray
- Society for Academic Emergency MedicineDes PlainesIllinoisUSA
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Han B, Yang JK, Ling AY, Ma M, Kipps AK, Shin AY, Beshish AG. Early Functional Status After Surgery for Congenital Heart Disease: A Single-Center Retrospective Study. Pediatr Crit Care Med 2022; 23:109-117. [PMID: 34593740 DOI: 10.1097/pcc.0000000000002838] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the change in functional status in infants, children, and adolescents undergoing congenital heart surgery using the Functional Status Scale. DESIGN A single-center retrospective study. SETTING A 26-bed cardiac ICU in a free-standing university-affiliated tertiary children's hospital. PATIENTS All patients 0-18 years who underwent congenital heart surgery from January 1, 2014, to December 31, 2017. INTERVENTIONS None. MEASUREMENTS AND MIN RESULTS The primary outcome variable was change in Functional Status Scale scores from admission to discharge. Additionally, two binary outcomes were derived from the primary outcome: new morbidity (change in Functional Status Scale ≥ 3) and unfavorable functional outcome (change in Functional Status Scale ≥ 5); their association with risk factors was assessed using modified Poisson regression. Out of 1,398 eligible surgical encounters, 65 (4.6%) and 15 (1.0%) had evidence of new morbidity and unfavorable functional outcomes, respectively. Higher Surgeons Society of Thoracic and the European Association for Cardio-Thoracic Surgery score, single-ventricle physiology, and longer cardiopulmonary bypass time were associated with new morbidity. Longer hospital length of stay was associated with both new morbidity and unfavorable outcome. CONCLUSIONS This study demonstrates the novel application of the Functional Status Scale on patients undergoing congenital heart surgery. New morbidity was noted in 4.6%, whereas unfavorable outcome in 1%. There was a small change in the total Functional Status Scale score that was largely attributed to changes in the feeding domain. Higher Society of Thoracic and the European Association for Cardio-Thoracic Surgery score, single-ventricle physiology, and longer cardiopulmonary bypass times were associated with new morbidity, whereas longer hospital length of stay was associated with both new morbidity and unfavorable outcome. Further studies with larger sample size will need to be done to confirm our findings and to better ascertain the utility of Functional Status Scale on this patient population.
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Affiliation(s)
- Brian Han
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA
| | - Jeffrey K Yang
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA
| | - Albee Y Ling
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA
| | - Alaina K Kipps
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA
| | - Andrew Y Shin
- Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital Stanford, Stanford University Medical Center, Palo Alto, CA
| | - Asaad G Beshish
- Department of Pediatrics, Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Abstract
This study examines differences in proportions of US medical school faculty who self-identified as Black or African American between 1990 and 2020 based on data from the Association of American Medical Colleges Faculty Roster.
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Affiliation(s)
| | - Albee Y. Ling
- Quantitative Sciences Unit, Stanford School of Medicine, Palo Alto, California
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Goldstein GP, Rao A, Ling AY, Ding VY, Chang IJ, Chock VY. Influence of enteral feeding and anemia on tissue oxygen extraction after red blood cell transfusion in preterm infants. Transfusion 2020; 60:466-472. [PMID: 31984520 DOI: 10.1111/trf.15680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding factors that impact tissue oxygen extraction may guide red blood cell (RBC) transfusion decision making in preterm infants. Our objective was to assess the influence of enteral feeding and anemia on cerebral and mesenteric oxygen saturation (Csat and Msat) and fractional tissue oxygen extraction (cFTOE and mFTOE) over the entire time course of RBC transfusion. STUDY DESIGN AND METHODS Preterm, very low-birth-weight infants receiving RBC transfusions at a single center were enrolled. Near-infrared spectroscopy sensors measured Csat and Msat levels from an hour before transfusion to 24 hours after. During this period, changes in Csat, Msat, cFTOE, and mFTOE were described, and their association with enteral feeding status and pretransfusion degree of anemia were assessed using generalized estimating equations. RESULTS RBC transfusion data from 31 preterm infants were included. Infants receiving enteral feeds exhibited lower pretransfusion Msat. Infants with pretransfusion hematocrit greater than 30% exhibited higher pretransfusion Csat and lower pretransfusion cFTOE. Such differences in baseline measurements persisted through 24 hours after transfusion. However, no statistically significant differences in oxygenation measures over time by enteral feeding or anemia status were identified. CONCLUSION Compared to NPO, enteral feeding was associated with lower Msat; anemia (hematocrit ≤30%) was associated with lower Csat and higher cFTOE. Over the time course of RBC transfusion, trajectories of Csat, Msat, cFTOE and mFTOE did not differ by enteral feeding or anemia status.
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Affiliation(s)
- Gregory P Goldstein
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Anoop Rao
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Albee Y Ling
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Victoria Y Ding
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Irene J Chang
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Zhang WY, Selamet Tierney ES, Chen AC, Ling AY, Fleischmann RR, Baker VL. Vascular Health of Children Conceived via In Vitro Fertilization. J Pediatr 2019; 214:47-53. [PMID: 31443895 PMCID: PMC6815705 DOI: 10.1016/j.jpeds.2019.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/03/2019] [Revised: 06/17/2019] [Accepted: 07/11/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether in vitro fertilization (IVF) has an effect on the cardiovascular health of offspring. STUDY DESIGN This was a cross-sectional pilot study. We performed vascular health assessment for 17 children aged 10-14 years who were conceived via IVF with autologous oocytes at Stanford University. Carotid artery ultrasound evaluated intima-media thickness and stiffness, carotid-femoral pulse wave velocity determined segmental arterial stiffness, and endothelial pulse amplitude testing assessed endothelial function. We compared IVF offspring with control adolescents assessed in the same laboratory, with all comparisons adjusted for age, sex, and race/ethnicity. RESULTS All participants had normal body mass index and blood pressure. Compared with controls, IVF children had thicker common carotid artery intima-media thickness (0.44 ± 0.03 mm vs 0.38 ± 0.03 mm; P < .01), higher elastic modulus (395.29 ± 185.33 mm Hg vs 242.79 ± 37.69 mm Hg; P = .01), higher βstiffness (2.65 ± 0.38 vs 2.28 ± 0.23; P < .01), and higher peak velocity (142.29 ± 31.62 cm/s vs 117.71 ± 32.69 cm/s; P = .04). The mean endothelial pulse amplitude testing reactive hyperemia index was not significantly different between IVF and controls. The mean pulse wave velocity was 4.69 ± 0.51 m/s compared with the controls 4.60 ± 0.57 m/s (P = .11), with 8 (47%) having abnormal values. CONCLUSION In an assessment of endothelial function and arterial properties of children conceived via IVF, we found that children conceived via IVF seem to have evidence of abnormal vascular health. Further studies with larger sample size and long-term follow-up are warranted.
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Affiliation(s)
- Wendy Y Zhang
- Stanford University School of Medicine, Stanford, CA.
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Angela C Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Albee Y Ling
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | | | - Valerie L Baker
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA; Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Baltimore, MD
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Ling AY, Kurian AW, Caswell-Jin JL, Sledge GW, Shah NH, Tamang SR. Using natural language processing to construct a metastatic breast cancer cohort from linked cancer registry and electronic medical records data. JAMIA Open 2019; 2:528-537. [PMID: 32025650 PMCID: PMC6994019 DOI: 10.1093/jamiaopen/ooz040] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/13/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023] Open
Abstract
Objectives Most population-based cancer databases lack information on metastatic recurrence. Electronic medical records (EMR) and cancer registries contain complementary information on cancer diagnosis, treatment and outcome, yet are rarely used synergistically. To construct a cohort of metastatic breast cancer (MBC) patients, we applied natural language processing techniques within a semisupervised machine learning framework to linked EMR-California Cancer Registry (CCR) data. Materials and Methods We studied all female patients treated at Stanford Health Care with an incident breast cancer diagnosis from 2000 to 2014. Our database consisted of structured fields and unstructured free-text clinical notes from EMR, linked to CCR, a component of the Surveillance, Epidemiology and End Results Program (SEER). We identified de novo MBC patients from CCR and extracted information on distant recurrences from patient notes in EMR. Furthermore, we trained a regularized logistic regression model for recurrent MBC classification and evaluated its performance on a gold standard set of 146 patients. Results There were 11 459 breast cancer patients in total and the median follow-up time was 96.3 months. We identified 1886 MBC patients, 512 (27.1%) of whom were de novo MBC patients and 1374 (72.9%) were recurrent MBC patients. Our final MBC classifier achieved an area under the receiver operating characteristic curve (AUC) of 0.917, with sensitivity 0.861, specificity 0.878, and accuracy 0.870. Discussion and Conclusion To enable population-based research on MBC, we developed a framework for retrospective case detection combining EMR and CCR data. Our classifier achieved good AUC, sensitivity, and specificity without expert-labeled examples.
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Affiliation(s)
- Albee Y Ling
- Biomedical Informatics Training Program, Stanford University, Stanford, CA.,Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | | | - George W Sledge
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nigam H Shah
- Department of Biomedical Data Science, Stanford University, Stanford, CA.,Center for Biomedical Informatics Research, Stanford University, CA
| | - Suzanne R Tamang
- Department of Biomedical Data Science, Stanford University, Stanford, CA.,Center for Population Health Sciences, Stanford University, CA
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14
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Tilghman JM, Ling AY, Turner TN, Sosa MX, Krumm N, Chatterjee S, Kapoor A, Coe BP, Nguyen KDH, Gupta N, Gabriel S, Eichler EE, Berrios C, Chakravarti A. Molecular Genetic Anatomy and Risk Profile of Hirschsprung's Disease. N Engl J Med 2019; 380:1421-1432. [PMID: 30970187 PMCID: PMC6596298 DOI: 10.1056/nejmoa1706594] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hirschsprung's disease, or congenital aganglionosis, is a developmental disorder of the enteric nervous system and is the most common cause of intestinal obstruction in neonates and infants. The disease has more than 80% heritability, including significant associations with rare and common sequence variants in genes related to the enteric nervous system, as well as with monogenic and chromosomal syndromes. METHODS We genotyped and exome-sequenced samples from 190 patients with Hirschsprung's disease to quantify the genetic burden in patients with this condition. DNA sequence variants, large copy-number variants, and karyotype variants in probands were considered to be pathogenic when they were significantly associated with Hirschsprung's disease or another neurodevelopmental disorder. Novel genes were confirmed by functional studies in the mouse and human embryonic gut and in zebrafish embryos. RESULTS The presence of five or more variants in four noncoding elements defined a widespread risk of Hirschsprung's disease (48.4% of patients and 17.1% of controls; odds ratio, 4.54; 95% confidence interval [CI], 3.19 to 6.46). Rare coding variants in 24 genes that play roles in enteric neural-crest cell fate, 7 of which were novel, were also common (34.7% of patients and 5.0% of controls) and conferred a much greater risk than noncoding variants (odds ratio, 10.02; 95% CI, 6.45 to 15.58). Large copy-number variants, which were present in fewer patients (11.4%, as compared with 0.2% of controls), conferred the highest risk (odds ratio, 63.07; 95% CI, 36.75 to 108.25). At least one identifiable genetic risk factor was found in 72.1% of the patients, and at least 48.4% of patients had a structural or regulatory deficiency in the gene encoding receptor tyrosine kinase (RET). For individual patients, the estimated risk of Hirschsprung's disease ranged from 5.33 cases per 100,000 live births (approximately 1 per 18,800) to 8.38 per 1000 live births (approximately 1 per 120). CONCLUSIONS Among the patients in our study, Hirschsprung's disease arose from common noncoding variants, rare coding variants, and copy-number variants affecting genes involved in enteric neural-crest cell fate that exacerbate the widespread genetic susceptibility associated with RET. For individual patients, the genotype-specific odds ratios varied by a factor of approximately 67, which provides a basis for risk stratification and genetic counseling. (Funded by the National Institutes of Health.).
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Affiliation(s)
- Joseph M Tilghman
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Albee Y Ling
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Tychele N Turner
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Maria X Sosa
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Niklas Krumm
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Sumantra Chatterjee
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Ashish Kapoor
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Bradley P Coe
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Khanh-Dung H Nguyen
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Namrata Gupta
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Stacey Gabriel
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Evan E Eichler
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Courtney Berrios
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
| | - Aravinda Chakravarti
- From the Center for Complex Disease Genomics, Johns Hopkins University School of Medicine, Baltimore (J.M.T., A.Y.L., T.N.T., M.X.S., S.C., A.K., K.-D.H.N., C.B., A.C.); the Department of Genome Sciences, University of Washington School of Medicine (T.N.T., N.K., A.K., B.P.C., E.E.E.), and the Howard Hughes Medical Institute, University of Washington (E.E.E.) - both in Seattle; and Broad Institute of Harvard and MIT, Cambridge, MA (K.-D.H.N., N.G., S.G.)
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Ling AY, Alsentzer E, Chen J, Banda JM, Tamang S, Minty E. Scalable Electronic Phenotyping For Studying Patient Comorbidities. AMIA Annu Symp Proc 2018; 2018:740-749. [PMID: 30815116 PMCID: PMC6371288] [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: 06/09/2023]
Abstract
Over 75 million Americans have multiple concurrent chronic conditions and medical decision making for these patients is mostly based on retrospective cohort studies. Current methods to generate cohorts of patients with comorbidities are neither scalable nor generalizable. We propose a supervised machine learning algorithm for learning comorbidity phenotypes without requiring manually created training sets. First, we generated myocardial infarction (MI) and type-2 diabetes (T2DM) patient cohorts using ICD9-based imperfectly labeled samples upon which LASSO logistic regression models were trained. Second, we assessed the effects of training sample size, inclusion of physician input, and inclusion of clinical text features on model performance. Using ICD9 codes as our labeling heuristic, we achieved comparable performance to models created using keywords as labeling heuristic. We found that expert input and higher training sample sizes could compensate for the lack of clinical text derived features. However, our best performing model included clinical text as features with a large training sample size.
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Affiliation(s)
- Albee Y Ling
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
| | - Emily Alsentzer
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
| | - Josephine Chen
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
| | - Juan M Banda
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA
| | - Suzanne Tamang
- Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Evan Minty
- Biomedical Informatics Training Program, Stanford University, Stanford, CA
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA
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Kwong C, Ling AY, Crawford MH, Zhao SX, Shah NH. A Clinical Score for Predicting Atrial Fibrillation in Patients with Cryptogenic Stroke or Transient Ischemic Attack. Cardiology 2017; 138:133-140. [PMID: 28654919 PMCID: PMC5683906 DOI: 10.1159/000476030] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Detection of atrial fibrillation (AF) in post-cryptogenic stroke (CS) or transient ischemic attack (TIA) patients carries important therapeutic implications. METHODS To risk stratify CS/TIA patients for later development of AF, we conducted a retrospective cohort study using data from 1995 to 2015 in the Stanford Translational Research Integrated Database Environment (STRIDE). RESULTS Of the 9,589 adult patients (age ≥40 years) with CS/TIA included, 482 (5%) patients developed AF post CS/TIA. Of those patients, 28.4, 26.3, and 45.3% were diagnosed with AF 1-12 months, 1-3 years, and >3 years after the index CS/TIA, respectively. Age (≥75 years), obesity, congestive heart failure, hypertension, coronary artery disease, peripheral vascular disease, and valve disease are significant risk factors, with the following respective odds ratios (95% CI): 1.73 (1.39-2.16), 1.53 (1.05-2.18), 3.34 (2.61-4.28), 2.01 (1.53-2.68), 1.72 (1.35-2.19), 1.37 (1.02-1.84), and 2.05 (1.55-2.69). A risk-scoring system, i.e., the HAVOC score, was constructed using these 7 clinical variables that successfully stratify patients into 3 risk groups, with good model discrimination (area under the curve = 0.77). CONCLUSIONS Findings from this study support the strategy of looking longer and harder for AF in post-CS/TIA patients. The HAVOC score identifies different levels of AF risk and may be used to select patients for extended rhythm monitoring.
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Affiliation(s)
- Calvin Kwong
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA
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