Developing an algorithm across integrated healthcare systems to identify a history of cancer using electronic medical records

OBJECTIVE

Tumor registries in integrated healthcare systems (IHCS) have high precision for identifying incident cancer but often miss recently diagnosed cancers or those diagnosed outside of the IHCS. We developed an algorithm using the electronic medical record (EMR) to identify people with a history of cancer not captured in the tumor registry to identify adults, aged 40-65 years, with no history of cancer.

MATERIALS AND METHODS

The algorithm was developed at Kaiser Permanente Colorado, and then applied to 7 other IHCS. We included tumor registry data, diagnosis and procedure codes, chemotherapy files, oncology encounters, and revenue data to develop the algorithm. Each IHCS adapted the algorithm to their EMR data and calculated sensitivity and specificity to evaluate the algorithm's performance after iterative chart review.

RESULTS

We included data from over 1.26 million eligible people across 8 IHCS; 55 601 (4.4%) were in a tumor registry, and 44848 (3.5%) had a reported cancer not captured in a registry. The common attributes of the final algorithm at each site were diagnosis and procedure codes. The sensitivity of the algorithm at each IHCS was 90.65%-100%, and the specificity was 87.91%-100%.

DISCUSSION

Relying only on tumor registry data would miss nearly half of the identified cancers. Our algorithm was robust and required only minor modifications to adapt to other EMR systems.

CONCLUSION

This algorithm can identify cancer cases regardless of when the diagnosis occurred and may be useful for a variety of research applications or quality improvement projects around cancer care.

beta-Hydroxybutyrate in developing nauplii of brine shrimp (Artemia franciscana K.) under feeding and non-feeding conditions

Body content of beta-hydroxybutyrate, and individual dry mass, carbon content, and survival rate, were studied in developing nauplii of the brine shrimp Artemia franciscana K. from hatching to 96-97 h post hatching at 27 +/- 1 degrees C. The effect of two diets was studied in the experiment: Super Selco (SS) with a high lipid content; and Protein Selco (PS) with a high protein content. A starving group (S) was used as reference. The level of beta-hydroxybutyrate at hatching was 0.6 nmol.ind-1; it increased to 1.0-1.5 nmol.ind-1 in the SS- and S-groups, while in the PS-group it remained stable between 0.6-0.8 nmol.ind-1. At 60-80 h post hatch in the SS- and S-groups, the levels of beta-hydroxybutyrate were similar to the initial levels. The survival rate remained higher than 95% until 24 h post hatching in all groups. At the end of the experiment, the survival rate was 63% in the PS-group, 13% in the S-group and 3% in the SS-group. The Artemia nauplii individual dry mass and carbon content remained relatively stable in the SS-group; both parameters showed a significant increase in the PS-group and a significant decrease in the S-group. The results suggest that Artemia nauplii utilise ketone bodies as a fuel during development and growth, but that ketone catabolism may be overloaded by excessive lipid feeding resulting in increased mortality and possibly a ketotic acidosis.

Implementation of substance use screening in prenatal clinics

BACKGROUND AND OBJECTIVES

To reduce women's consumption of alcohol and other drugs during pregnancy, the Department of Epidemiology for the Aberdeen Area Indian Health Service (AAIHS) promoted a maternal substance use screening program for prenatal clinics in 1992. This report describes the adherence to the screening protocol at AAIHS facilities and barriers to such screening.

METHODS

Prenatal clinic staff members at 20 AAIHS health care facilities were surveyed to determine the extent of prenatal substance use screening and the barriers to its implementation. The medical records of a random sample of 235 women who sought prenatal care at five hospitals were reviewed to determine whether prenatal clinic staff adhered to the screening protocol.

RESULTS

Of the 20 health care facilities, 13 (65%) had implemented the screening. The major barriers to implementing screening were lack of training in prenatal substance use screening and lack of clinic staff designated to administer the screening protocol. Though not statistically significant, our data suggest that women not administered the screening questionnaire were more likely to be multiparous (prevalence ratio = 2.1; 95% confidence interval = 0.9, 4.5).

CONCLUSIONS

To improve screening of pregnant women for substance use, prenatal clinic staff members should address administrative barriers and assess adherence of health care providers and patients to the screening protocol. Training of prenatal clinic personnel is essential to implement optimal maternal substance use screening in prenatal clinics.

Age-dependent accumulation of advanced glycation end-products in adult Drosophila melanogaster

Advanced glycation end-product(s) (AGE) are formed in biological systems when reducing sugars react with amino groups on proteins. Long-lived proteins such as collagen and lens crystallins are known to be susceptible to AGE modification and may play a major role in the development of diabetes and other age-related pathologies. It has been previously suggested that AGE formation might affect the lifespan of experimental animals. Our study is the first to examine the effect of AGE accumulation on the life span of an organism, Drosophila melanogaster. We found that Drosophila melanogaster maintained at 24 degrees C accumulate significant AGE over their lifespan. Young flies (10 days old) had 44% less AGE than senescent flies (75 days old). We were able to reduce AGE accumulation in Drosophila melanogaster by raising the flies on a medium containing a known AGE inhibitor, aminoguanidine HCl. Reduction of AGE in flies failed to increase their mean lifespan, and high concentrations (40 mM) reduced the mean life span, which suggests that aminoguanidine is toxic at levels near those required for inhibition of AGE formation. However, the common fruit fly, Drosophila melanogaster, provides a simple model system to study the age-dependent accumulation of glycated proteins and their inhibition by novel compounds.