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1
Fountoulakis, Konstantinos N. "The Contemporary Face of Bipolar Illness: Complex Diagnostic and Therapeutic Challenges." CNS Spectrums 13, no. 9 (September 2008): 763–79. http://dx.doi.org/10.1017/s1092852900013894.
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AbstractManic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the “classic” bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.
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Ridgway, Jessica P., Jessica Schmitt, Ellen Almirol, Monique Millington, Erika Harding, and David Pitrak. "Electronic data sharing between public health department and clinical providers improves accuracy of HIV retention data." Open Forum Infectious Diseases 4, suppl_1 (2017): S421—S422. http://dx.doi.org/10.1093/ofid/ofx163.1059.
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Abstract Background Retention in care is critical for treatment and prevention of HIV. Many HIV care clinics measure retention rate, but data are often incomplete for patients who are classified as lost to follow-up but may be actually in care elsewhere, moved, or died. The Data to Care (D2C) initiative supports data sharing between health departments and HIV providers to confirm patient care status and facilitate reengagement efforts for out of care HIV patients. Methods The University of Chicago Medicine (UCM) provided an electronic list to the Chicago Department of Public Health (CDPH) of adult HIV-positive patients whose retention status was not certain. Retention in care was defined as at least 2 visits >90 days apart within the prior 12 months. CDPH matched this list of patients with data from the Chicago electronic HIV surveillance database. Matches were based on patient name, including alternative spellings and phonetics, and birth date. CDPH also cross-checked patient names with the CDC’s national enhanced HIV-AIDS Reporting System (eHARS) database. CDPH provided UCM with patient current care status, i.e., patient was in care elsewhere (as verified by lab data), moved out of state, or deceased. Results 780 HIV-positive patients received care in the UCM adult HIV clinic from January 1, 2013 to March 31, 2017. Of these, 360 were retained in care as of March 2017. We shared data with CDPH for 492 patients. Of these, 294 (59.8%) were matched, and 168 (34.1%) had a date of last medical care provided. See Table 1 for patient dispositions, before and after data sharing. 24 (13.4%) of patients believed to be lost to follow up according to UCM records were confirmed either transferred care or deceased according to health department data. Conclusion Data sharing between the health department and HIV providers can improve data accuracy regarding retention in care among people living with HIV. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient
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Matthews, Peter C. "Pathological Habit Disorder?" Canadian Journal of Psychiatry 33, no. 9 (December 1988): 826–29. http://dx.doi.org/10.1177/070674378803300908.
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This paper outlines a diagnostic entity called ‘Pathological Habit Disorder’ which is suggested for inclusion in the DSM as an Axis II option. Specific areas of concern, either mental (Axis I) or physical (Axis III), would delineate the syndrome. Pathological Habit Disorder (PHD) points to treatment options where the syndrome is wholly or partly habit-driven. Whether the syndrome is habit-driven or not will remain a clinical judgement even though many conditions, previously thought immutable except by medication, are proving accessible to behavioural engineering. In the ICD system, PHD seems to fit in “Special Symptoms or Syndromes not elsewhere Classified”. It is demonstrably useful to have a diagnosis such as PHD and to incorporate it into the body of medical classification, recognizing current practices for dealing with unwelcome or damaging habits.
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Pogorzelczyk, Katarzyna, Joanna Synoweć, Andrzej Basiński, Daniel Ślęzak, Marlena Robakowska, Przemysław Żuratyński, and Wioletta Mędrzycka-Dąbrowska. "Cost analysis of treating pain patients on the example of the Clinical accident ward Of university Clinical Centre in Gdańsk." BÓL 20, no. 2 / Zjazd PTBB (September 17, 2019): 1–6. http://dx.doi.org/10.5604/01.3001.0013.4614.
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The cost analysis of pain treatment is not a topic often taken up by the health economists community. The subjective dimension and pain assessment by the patient is one of the main determinants of the lack of interest in this topic. Work carried out on this topic currently includes analysis accompanying the process of pharmacotherapy treatment, care provided by medical personnel as well as costs resulting from administrative services. The aim of the work is to present the cost analysis of care for a „pain” patient and to indicate the most optimal financial package of these activities. The study was performed on the basis of financial data of the Clinical Emergency Department of the University Clinical Center in Gdańsk for the last year. We analyzed the cases of patients complaining of pain who received pharmacotherapy. Results The total cost for 2017 amounted to 1.128.668 PLN. The largest amount of money was allocated to the group of patients qualified to the group R: „Symptoms, disease features and abnormal results of clinical trials not classified elsewhere” – 327.313.72 PLN. The symptom of pain is one of the most frequently indicated symptoms among patients who receive medical help at the Clinical Emergency Department of the University Clinical Center in Gdańsk, which should be associated with a greater degree of involvement in analgesic therapy in patients who require it.
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DeVivo, Renée, Lauren Zajac, Asim Mian, Anna Cervantes-Arslanian, Eric Steinberg, Michael L. Alosco, Jesse Mez, Robert Stern, and Ronald Killany. "Differentiating Between Healthy Control Participants and Those with Mild Cognitive Impairment Using Volumetric MRI Data." Journal of the International Neuropsychological Society 25, no. 08 (May 27, 2019): 800–810. http://dx.doi.org/10.1017/s135561771900047x.
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AbstractObjective:To determine whether volumetric measures of the hippocampus, entorhinal cortex, and other cortical measures can differentiate between cognitively normal individuals and subjects with mild cognitive impairment (MCI).Method:Magnetic resonance imaging (MRI) data from 46 cognitively normal subjects and 50 subjects with MCI as part of the Boston University Alzheimer’s Disease Center research registry and the Alzheimer’s Disease Neuroimaging Initiative were used in this cross-sectional study. Cortical, subcortical, and hippocampal subfield volumes were generated from each subject’s MRI data using FreeSurfer v6.0. Nominal logistic regression models containing these variables were used to identify subjects as control or MCI.Results:A model containing regions of interest (superior temporal cortex, caudal anterior cingulate, pars opercularis, subiculum, precentral cortex, caudal middle frontal cortex, rostral middle frontal cortex, pars orbitalis, middle temporal cortex, insula, banks of the superior temporal sulcus, parasubiculum, paracentral lobule) fit the data best (R2= .7310, whole model test chi-square = 97.16,p< .0001).Conclusions:MRI data correctly classified most subjects using measures of selected medial temporal lobe structures in combination with those from other cortical areas, yielding an overall classification accuracy of 93.75%. These findings support the notion that, while volumes of medial temporal lobe regions differ between cognitively normal and MCI subjects, differences that can be used to distinguish between these two populations are present elsewhere in the brain.
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Patten, Scott B., and Joel Paris. "The Bipolar Spectrum—A Bridge Too Far?" Canadian Journal of Psychiatry 53, no. 11 (November 2008): 762–68. http://dx.doi.org/10.1177/070674370805301108.
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Objectives: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. Methods: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. Results: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. Conclusions: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.
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Telemi, Edvin, Nikolay L. Martirosyan, Mauricio J. Avila, Ashley L. Lukefahr, Christopher Le, and G. Michael Lemole. "Suprasellar pleomorphic xanthoastrocytoma: A case report." Surgical Neurology International 10 (April 24, 2019): 72. http://dx.doi.org/10.25259/sni-83-2019.
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Background: Pleomorphic xanthoastrocytoma (PXA) is a rare form of astrocytic neoplasm most commonly found in children and young adults. This neoplasm, which is classified as a Grade II tumor by the World Health Organization classification of tumors of the central nervous system, carries a relatively favorable outcome. It is usually found supratentorially in cortical regions of the cerebral hemispheres, and as such, presenting symptoms are similar to other supratentorial cortical neoplasms; with seizures being a common initial symptom. Due to the rarity of this type of neoplasm, PXA arising elsewhere in the brain is often not included in the initial differential diagnosis. Case Description: This report presents an extremely rare patient with PXA arising in the suprasellar region who presented with progressive peripheral vision loss. Magnetic resonance imaging of the brain demonstrated a heterogeneous suprasellar mass with cystic and enhancing components initially; the most likely differential diagnosis was craniopharyngioma. The patient underwent endoscopic endonasal resection of the tumor. Microscopically, the tumor was consistent with a glial neoplasm with variable morphology. Based on these findings along with further immunohistochemical workup, the patient was diagnosed with a PXA arising in the suprasellar region. At the 1-year follow-up, the patient remained free of recurrence. Although rare PXA originating in other uncommon locations, such as the spinal cord, cerebellum, the ventricular system, and the pineal region have been previously described. Conclusion: Although rare, PXA should be included in the differential diagnosis for solid-cystic tumors arising in the suprasellar region in young adults.
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Söderström, Lisa, Andreas Rosenblad, Eva Thors Adolfsson, and Leif Bergkvist. "Malnutrition is associated with increased mortality in older adults regardless of the cause of death." British Journal of Nutrition 117, no. 4 (February 28, 2017): 532–40. http://dx.doi.org/10.1017/s0007114517000435.
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AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
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Asah, Cresta, Rune Frandsen, Rikke Ibsen, Jakob Kjellberg, and Poul Jennum. "Morbidity, Mortality, and Conversion to Neurodegenerative Diseases in Patients with REM Sleep Behavior Disorder and REM Sleep without Atonia." Neuroepidemiology 55, no. 2 (2021): 141–53. http://dx.doi.org/10.1159/000514175.
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<b><i>Introduction:</i></b> The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. <b><i>Methods:</i></b> All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson’s disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer’s, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. <b><i>Results:</i></b> In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. <b><i>Conclusions:</i></b> A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.
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Ovadia, Yaniv S., Dov Gefel, Dorit Aharoni, Svetlana Turkot, Shlomo Fytlovich, and Aron M. Troen. "Can desalinated seawater contribute to iodine-deficiency disorders? An observation and hypothesis." Public Health Nutrition 19, no. 15 (May 6, 2016): 2808–17. http://dx.doi.org/10.1017/s1368980016000951.
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AbstractObjectiveOver 300 million people rely on desalinated seawater and the numbers are growing. Desalination removes iodine from water and could increase the risk of iodine-deficiency disorders (IDD). The present study assessed the relationship between iodine intake and thyroid function in an area reliant on desalination.DesignA case–control study was performed between March 2012 and March 2014. Thyroid function was rigorously assessed by clinical examination, ultrasound and blood tests, including serum thyroglobulin (Tg) and autoimmune antibodies. Iodine intake and the contribution made by unfiltered tap water were estimated by FFQ. The contribution of drinking-water to iodine intake was modelled using three iodine concentrations: likely, worst-case and best-case scenario.SettingThe setting for the study was a hospital located on the southern Israeli Mediterranean coast.SubjectsAdult volunteers (n102), 21–80 years old, prospectively recruited.ResultsAfter screening, seventy-four participants met the inclusion criteria. Thirty-seven were euthyroid controls. Among those with thyroid dysfunction, twenty-nine were classified with non-autoimmune thyroid disease (NATD) after excluding eight cases with autoimmunity. Seventy per cent of all participants had iodine intake below the Estimated Average Requirement (EAR) of 95 µg/d. Participants with NATD were significantly more likely to have probable IDD with intake below the EAR (OR=5·2; 95 % CI 1·8, 15·2) and abnormal serum Tg>40 ng/ml (OR=5·8; 95 % CI 1·6, 20·8).ConclusionsEvidence of prevalent probable IDD in a population reliant on desalinated seawater supports the urgent need to probe the impact of desalinated water on thyroid health in Israel and elsewhere.
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Lindskou, Tim Alex, Laura Pilgaard, Morten Breinholt Søvsø, Torben Anders Kløjgård, Thomas Mulvad Larsen, Flemming Bøgh Jensen, Ulla Møller Weinrich, and Erika Frischknecht Christensen. "Prehospital dyspnoea patients in the North Denmark Region." Dansk Tidsskrift for Akutmedicin 2, no. 3 (April 30, 2019): 41. http://dx.doi.org/10.7146/akut.v2i3.112947.
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Background: Prehospital dyspnoea patients are a frequent group with a high mortality. However, there is limited knowledge about their characteristics. We aimed to investigate causes for dispatched ambulances to patients diagnosed with dyspnoea, and diagnoses given to patients to whom an ambulance was dispatched due to dyspnoea.
Method: Retrospective cohort study in the North Denmark region in the period 2012-2015. We included all emergency ambulance patients where the main cause for a dispatched ambulance was “Breathing difficulty”, and all emergency ambulance patients who were diagnosed within the ICD-10 chapter “Diseases of the respiratory system” at hospital.
Results: 4933 patients had an ambulance dispatched due to “Breathing difficulty”. Their most frequent diagnoses at hospital were ICD-10 chapter “Diseases of the respiratory system” (49.45%), “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” (18.56%), “Diseases of the circulatory system” (9.20%), and “Factors influencing health status and contact with health services” (5.71%). Contrariwise, 5163 emergency ambulance patients received a diagnosis within ICD-10 chapter “Diseases of the respiratory system” at hospital. The most frequent causes for dispatched ambulances to these patients were “Breathing difficulty” (49.45%), “Unclarified problem” (11.16%), and “Chest pain - heart disease” (9.55%). 16.00% of dispatches were without cause.
Conclusion: Only half of the patients had both ambulance dispatch and hospital diagnose related to breathing difficulties. The variation and distribution of causes for ambulance dispatch and diagnoses given at hospital, suggests that dyspnoea is a symptom present in many conditions and the patient group is complex.
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Rajeshreddy V., S. G. S., and Lokesh V. Patil. "Causality assessment and the severity of the adverse drug reactions in tertiary care hospital: a pharmacovigilance study." International Journal of Basic & Clinical Pharmacology 6, no. 12 (November 23, 2017): 2800. http://dx.doi.org/10.18203/2319-2003.ijbcp20175073.
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Background: Adverse drug reactions (ADRs) constitute a major clinical problem in terms of human suffering and increased health care costs. To study the adverse drug reactions reported in a tertiary care hospital and study of causality assessment and severity of adverse drug reaction (ADR) cases reported.Methods: A prospective observational study was conducted as part of pharmacovigilance program over 12months between September 2015 and August 2016. Adverse drug reactions reported from hospital were filled into Suspected ADR - CDSCO forms and submitted to pharmacovigilance unit. Causal relationship was assessed and categorized by Naranjo’s algorithm and WHO - UMC causality scale. The severity of each ADR was assessed using Modified Hartwig and Siegel scale.Results: Total 120 cases were reported over 12 months. Among them, 66% were in males and 55% were in females. The majority of ADRs were due to antimicrobial agents (40.78%) followed by haematinics (12%) and anti-epileptics (10%). Maximum number of patients (30.25%) reported with dermatological manifestations. Highest number of ADRs was reported from the department of medicine (45%). As per Naranjo’s scale, 54% reports were assessed as probable and 46% classified as possible. Majority of cases were mild to moderate in severity.Conclusions: The pattern of ADRs reported in our hospital is similar with the pattern of studies conducted in other hospitals elsewhere. This study provides a database of ADRs due to commonly used drugs in our hospital, which will help clinicians for their optimum and safe use. Hence effective pharmacovigilance is required for the use of these drugs and their safety assessment.
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Holst, Søren, Dorte Lystrup, and John L. Taylor. "Firesetters with intellectual disabilities in Denmark." Journal of Intellectual Disabilities and Offending Behaviour 10, no. 4 (November 28, 2019): 72–81. http://dx.doi.org/10.1108/jidob-10-2019-0021.
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Purpose The purpose of this paper is to gather epidemiologicalinformation concerning firesetters with intellectual disabilities (ID) in Denmark to identify the assessment and treatment needs of this population and inform further research in this area. Design/methodology/approach The records held by the Danish Ministry of Justice concerning all firesetters with ID convicted of deliberate firesetting were reviewed for the period January 2001 to December 2010 inclusive. File information was extracted for 83 offenders concerning: demographic and personal characteristics; mental health characteristics; offending behaviour; offence-specific factors; and motives for offending. A sub-group of seven offenders were interviewed to explore some of the themes that emerged from the file review. Findings The majority of study participants were male and were classified as having mild ID and around 50 per cent had additional mental health problems. Many came from disturbed and deprived backgrounds. Two-thirds had set more than one fire and over 60 per cent had convictions for offences other than firesetting. Alcohol was involved in the firesetting behaviour in a significant proportion of cases (25 per cent). The motives for setting fires were – in descending order – communication (of anger, frustration and distress), fire fascination and vandalism. Interviews with participants indicated the important communicative function of firesetting, the difficulties people had in talking about and acknowledging their firesetting behaviour, and lack of access to targeted interventions. Research limitations/implications Interventions for Danish firesetters with ID, as for firesetters with ID elsewhere, need to target the communicative function of this behaviour, along with offenders’ lack of insight and initial reluctance to accept responsibility for their behaviour and associated risks. Adjunctive treatment is required to address the psychiatric comorbidity experienced by many of these offenders, along with the alcohol use/misuse that is associated with many of these offences. Originality/value This is the first study concerning nature and needs of firesetters with ID in Denmark.
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Waller, Michael, Rachel F. Buckley, Colin L. Masters, Francis R. Nona, Sandra J. Eades, and Annette J. Dobson. "Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study." Journal of Alzheimer's Disease 81, no. 4 (June 15, 2021): 1589–99. http://dx.doi.org/10.3233/jad-201175.
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Background: The prevalence of dementia is generally reported to be higher among Indigenous peoples. Objective: The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. Methods: De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer’s Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as ‘unspecified’ type in Indigenous Australians. Results: The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as ‘unspecified’ on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group. Conclusion: This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.
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Chapman, Alec B., Kelly Peterson, Wathsala Widanagamaachchi, and Makoto M. Jones. "616. Predicting Misdiagnoses of Infectious Disease in Emergency Department Visits." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S411. http://dx.doi.org/10.1093/ofid/ofab466.814.
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Abstract Background Diagnostic error leads to delays of care and mistaken therapeutic decisions that can cascade in a downward spiral. Thus, it is important to make accurate diagnostic decisions early on in the clinical care process, such as in the emergency department (ED). Clinical data from the Electronic Health Record (EHR) could identify cases where an initial diagnosis appears unusual in context. This capability could be developed into a quality measure for feedback. To that end, we trained a multiclass machine learning classifier to predict infectious disease diagnoses following an ED visit. Methods To train and evaluate our classifier, we sampled ED visits between December 31, 2016, and December 31, 2019, from Veterans Affairs (VA) Corporate Data Warehouse (CDW). Data elements used for prediction included lab orders and results, medication orders, radiology procedures, and vital signs. A multiclass XGBoost classifier was trained to predict one of five infectious disease classes for each ED visit based on the clinical variables extracted from CDW. Our model was trained on an enriched sample of 916,562 ED visits and evaluated on a non-enriched blind testing set of 356,549 visits. We compared our model against an ensemble of univariate Logistic Regression models as a baseline. Our model was trained to predict for an ED visit one of five infectious disease classes or “No Infection”. Labels were assigned to each ED visit based on ICD-9/10-CM diagnosis codes used elsewhere and other structured EHR data associated with a patient between 24 hours prior to an ED visit and 48 hours after. Results Classifier performance varied across each of the five disease classes (Table 1). The classifier achieved the highest F1 and AUC for UTI, the lowest F1 for Sepsis, and the lowest AUC for URI. We compared the average precision, recall and F1 scores of the multiclass XGBoost with the ensemble of Logistic Regression models (Table 2). XGBoost achieved higher scores in all three metrics. Table 1. Classification performance XGBoost testing set performance in each disease class, visits with no labels, and macro average. The infectious disease classes with the highest score in each metric are shown in bold. Table 2. Baseline comparison Macro average scores for XGBoost and baseline classifiers. Conclusion We trained a model to predict infectious disease diagnoses in the Emergency Department setting. Future work will further explore this technique and combine our supervised classifier with additional signs of medical error such as increased mortality or anomalous treatment patterns in order to study medical misdiagnosis. Disclosures All Authors: No reported disclosures
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Castañeda-Mendez, Paulo F., José Luis Castillo-Álvarez, Armando Barragán-Reyes, Daniela Bay-Sansores, Jessica Isabel Pulido-Enríquez, Luis Humberto González-Ramírez, Maria Lorena Cabrera-Ruiz, Daniel Aguilar-Zapata, Javier Reyes-Mar, and Luis Enrique Soto-Ramírez. "439. Clinical Characteristics and Mortality of an Initial Cohort of COVID-19 Patients in México City." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S287. http://dx.doi.org/10.1093/ofid/ofaa439.632.
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Abstract Background As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results 85 patients were included, median age 53.5 years; 69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2–45}]; 5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14–25}]. In all patients, the total length of hospitalization was 12.1 days [range {2–52}], 14.8 days [range {3–52}] in ICU patients, and 6.7 days [range {2–30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population. Disclosures All Authors: No reported disclosures
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Rosić, Nataša. "Unknown and ill-defined causes of death in the mortality of the populations of Serbia, Croatia, North Macedonia, and Slovenia, in the period between 2007 and 2016." Srpski medicinski casopis Lekarske komore 2, no. 2 (2021): 23–32. http://dx.doi.org/10.5937/smclk2-32461.
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Introduction: Data on the cause of death form the cornerstone for analyzing the health situation and disease in countries, and they make a major contribution to building evidence for health policies. Aim: The aim of this study was to determine the extent to which diagnoses from the group - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), International Classification of Diseases (ICD - Revision X) were used as the main cause of death in Serbia, Croatia, North Macedonia, and Slovenia in the ten-year period, 2007 - 2016. Materials and methods: Methods of descriptive and analytical statistics were used in this research. An analysis of data on the causes of death (R00-R99 ICD - Revision X), by gender, during the ten-year period (2007 - 2016) was performed. Linear regression was also used as an analytical method to analyze the trend. Results: During the ten-year period, in Serbia, the R00-R99 diagnoses were among the five most common groups of diagnoses of death, i.e., in each year they took third place, with a percentage of 4.7%. In the observed period, in the surrounding countries, there was an increase in the death rate in Slovenia, with the highest rate in 2016 (19.9), while in Croatia there was a decrease in the death rate related to the diagnoses from group XVIII ICD - X (R00-R99). In Macedonia, the rate had a linear trend, with a slight decline in 2012 (52.3) and 2013 (58.7). In the observed period, an increase in the death rate of the population of Serbia with an unknown cause of death was observed, with particularly high rates in 2009 and 2016. Comparative analysis has shown that R00-R99 diagnoses are represented more in the mortality statistics of Serbia than in Slovenia and Croatia, and less than in Northern Macedonia. Conclusion: Urgent interventions are needed to improve the quality of mortality statistics and data on the causes of death in the described countries.
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Duron, Rebecca, Michael Mugavero, and Andrew Westfall. "2497." Journal of Clinical and Translational Science 1, S1 (September 2017): 81. http://dx.doi.org/10.1017/cts.2017.286.
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OBJECTIVES/SPECIFIC AIMS: Approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. This has substantial implications for both individual and public health outcomes. On an individual level, being retained in care is necessary for continuous receipt of antiretroviral therapy and sustained viral suppression. The public health implications of poor retention in HIV care are also serious, as it is estimated that people with HIV who are not retained in medical care are responsible for a majority of HIV transmissions, even more than the number of transmissions attributable to those who are HIV infected but undiagnosed. State departments of health routinely collect surveillance data including positive HIV test results, CD4 counts and viral load measures for monitoring trends in HIV infection. A shift in the use of these surveillance measures, guided by the CDC, has brought forth the opportunity to use these data for direct patient services and, more specifically, to direct re-engagement and retention in care efforts. Although the risk factors for poor retention in HIV care have been characterized using information from individual or multiple clinics, this study seeks to incorporate state surveillance data into the retention measures. METHODS/STUDY POPULATION: This retrospective cohort study was performed at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic among patients with at least one attended HIV primary care visit during the calendar year of 2015. Retention during the calendar year of 2016 was then measured as whether or not a patient had 2 or more completed clinic visits which were separated by more than 90 days (in accordance with the Health Resources and Services Administration or HRSA guidelines, a National HIV Quality Indicator). For patients who did not have any primary care visit in 2016, the Alabama Department of Public Health will provide a status of care (out of care, in care elsewhere, died, moved out of state, and cannot locate) based on HIV laboratory results reported from all clinics and labs across the state and/or mortality information. A multinominal regression model of the status of care will be fitted to demographic, clinical, laboratory, and behavioral patient reported outcomes captured during an index visit in 2015. RESULTS/ANTICIPATED RESULTS: Data were recently obtained and is currently being analyzed on 3107 patients included in this study. We anticipate that there will be differences in the factors significantly associated with patients classified as out of care, poorly retained (patients who have only one completed clinic visit), and retained in care by the HRSA measure during calendar year 2016. DISCUSSION/SIGNIFICANCE OF IMPACT: By incorporating state surveillance data into our analysis, we expect to obtain a more precise picture of the risk factors for poor retention among HIV patients. For the first time, we will be able to determine if patients lost to our HIV clinic (~10% annually) are entirely lost to medical care or are seeking care elsewhere as indicated by HIV lab data reported to public health via surveillance. Identified risk factors will then be able to better inform the efforts to proactively improve the efficiency for HIV patient retention and re-engagement, and therefore lead to better individual outcomes for HIV patients and reduce the incidence of new HIV cases.
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Christensen, Karoline Bjerg. "Diagnoses and mortality for patients with unclear problems calling for an ambulance." Dansk Tidsskrift for Akutmedicin 5, no. 1 (March 27, 2022): 9. http://dx.doi.org/10.7146/akut.v5i1.132151.
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Danish patients calling the Emergency Medical Services (EMS) with unclear problems are assigned a Danish Index for Emergency Care (DI) criteria called ‘unclear problem’. Previous Danish studies found ‘unclear problem’ in 17% and 19% of all emergency calls. In the Emergency Departments, unclear problems identified as non-specific symptoms are well documented. We investigated EMS patients given an ‘unclear problem’ DI-criteria prehospitally, their hospital discharge diagnoses and 1-day and 30-day mortality rates.
Population-based observational cohort study investigating 7,935 EMS patients who received the DI-criteria ‘unclear problem’ upon an emergency call and who were brought to hospital in the North Denmark Region during January 1st, 2016 – December 31st, 2018. Outcome variables were; number of emergency ambulances dispatched, ‘unclear problem’ DI-criteria, and vital status (dead or alive) 30 days after hospital contact. We evaluated the association between ICD-10 diagnosis chapters and mortality adjusted for age, gender, and comorbidity. ICD-10 chapters 18: “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” and 21: “Factors influencing health status and contact with health services” were defined as ‘non-specific diagnoses’.All ICD-10 chapters were represented in the discharge diagnoses. The majority (40.4%) were non-specific diagnoses. Common discharge diagnoses were circulatory (9.6%), injuries and poisoning (9.4%), and respiratory diseases (6.9%). Overall mortality rates were for 1-day and 30-day 2.3% (n=181) and 7.1% (n=566), respectively. Day 1 mortality rates were highest for circulatory diseases (8.6%), infections (5.4%), and respiratory diseases (4.0%). Mortality on day 30 was 2.6% and 4.1% for non-specific diagnoses, whereas circulatory, respiratory diagnoses and infections exhibted highest mortality rates. Risk of mortality was associated with age and comorbidities and when adjusted for these confounders, mortality rates decreased for all diagnoses.
EMS patients assigned ‘unclear problem’ and brought to the hospital received diagnoses from all ICD-10 chapters, the majority with non-specific diagnoses, followed by injuries and poisoning, circulatory and respiratory diseases. The latter two groups exhibited the highest crude mortality rates, decreasing substantially when adjusted for age and comorbidity. Mortality rates among patients with unclear problems were associated with age and comorbidities rather than the unclear emergency medical call and following discharge diagnoses.
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Komori, Takashi. "S4-KL-1 UPDATE OF WHO2016 CLASSIFICATION OF ADULT DIFFUSE GLIOMAS." Neuro-Oncology Advances 1, Supplement_2 (December 2019): ii3—ii4. http://dx.doi.org/10.1093/noajnl/vdz039.014.
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Abstract The World Health Organization (WHO) central nervous system (CNS) tumor classification has represented the primary source of diagnosis and grading criteria of brain tumors. Nonetheless, recent advances of studies on their molecular alterations require more rapid update of recommendations for clinical practice. To accomplish this, cIMPACT-NOW (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy) was established in 2016 and has published four updates. For adult gliomas, update 1 clarified the use of the term NOS (Not Otherwise Specified) and proposed a new term NEC (Not Elsewhere Classified); update 2 revised clarifications regarding diffuse astrocytoma/anaplastic astrocytoma, IDH-mutant; update 3 proposed molecular criteria for an IDH-wildtype diffuse or anaplastic astrocytic glioma without histological features of glioblastoma, which would behave similarly to a grade IV glioblastoma. Nonetheless, no consensus on pathologic or molecular markers that could be incorporated into a more clinically relevant grading scheme for IDH-mutant gliomas has been reached. The molecular alterations previously studied using relatively large cohorts include CDKN2A/B homozygous deletion, CDK4 amplification, RB1 mutation/homozygous deletion, PIK3CA or PIK3R1 mutations, PDGFRA amplification, NMYC amplification, global hypomethylation, genomic instability and chromosome 14 loss. The proliferative activity, based on the mitotic count or Ki67 indices, and other morphologic features typical of a high grade that might stratify the risk better than the current criteria have also been evaluated. Despite the discordance among the results of previous studies, CDKN2A/2B homozygous deletions have been shown prognostic significance in high-grade IDH-mutant astrocytomas and microvascular proliferation stratifies IDH-mutant gliomas lacking a CDKN2A homozygous deletion, suggesting that the integration of molecular information and traditional histological findings is still essential for achieving maximum risk stratification of adult cases of IDH-mutant diffuse gliomas. The grading scheme for adult IDH-mutant as well as wild-type gliomas should therefore be revised in the next WHO update.
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Gulati, Bal Kishan, Anil Kumar, and Arvind Pandey. "Cause of death by verbal autopsy among women of reproductive age in Rajasthan, India." International Journal of Scientific Reports 1, no. 1 (May 2, 2015): 56. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20150202.
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<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Reliable data on mortality and morbidity among women of reproductive age are scarce in India. The present study is the Rajasthan component of a large multi-centric study on cause of death by verbal autopsy conducted in five states of India. The data pertaining to deaths among women of reproductive age are presented. </p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>House-to-house surveys of a representative population from rural and urban areas in six districts of Rajasthan were undertaken by Probability of Proportion to Size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared for the purpose. International Classification of Diseases - ICD-10 was used to code the assigned cause of death. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 231 deaths of women of reproductive age were investigated, of which 36 (16%) were maternal deaths while 195 (84%) were non-maternal deaths. Nine out of ten maternal deaths were in rural area.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Certain infectious and parasitic diseases; pregnancy, childbirth and the puerpurium; injury, poisoning and other consequences of external causes; and symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified were found to be the major killers among the women of reproductive age. A comprehensive approach that includes in addition to reproductive health interventions, interventions addressing underlying illiteracy among women and social reforms needs to be undertaken. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>Maternal deaths, Non-maternal deaths, Women of reproductive age, Verbal autopsy</p>
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Ho, Gwendolyn, Ted Wun, Qian Li, Ann M. Brunson, Aaron S. Rosenberg, Brian Jonas, and Theresa Keegan. "Decreased Early Mortality Associated with Treatment of Acute Myeloid Leukemia (AML) at NCI-Designated Cancer Centers in California." Blood 128, no. 22 (December 2, 2016): 391. http://dx.doi.org/10.1182/blood.v128.22.391.391.
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Abstract Background Patients with solid tumors treated at a National Cancer Institute designated cancer center (NCI-CC) have been found to have improved survival when compared to those treated elsewhere. Few population-based studies have evaluated the association between location of care, complications associated with intensive therapy and early mortality (defined here as death ² 60 days from diagnosis) in patients with AML. Methods Using linked data from the California Cancer Registry and Patient Discharge Dataset from 1999 to 2012, we identified patients ³15 years of age diagnosed with AML who received inpatient treatment. Hospitals where patients received their care were classified as either NCI-CC or non-NCI designated facilities (non-NCI-CC). Logistic regression was used to estimate associations between patient characteristics (age, sex, race/ethnicity, year of diagnosis, marital status, neighborhood socioeconomic status, health insurance, and medical comorbidities) and location of care (NCI-CC vs non-NCI-CC facilities), and then to build a propensity score. Inverse probability weighted logistic regression models were used to determine associations between location of care and complications with early mortality. Interactions of complications and location of care with early mortality were also considered. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results Of the 5613 patients with AML identified, 1406 (25%) were treated at an NCI-CC. Compared to patients treated elsewhere, AML patients treated at an NCI-CC were more likely to be <65 years of age, Hispanic (versus non-Hispanic white), live in higher socioeconomic status neighborhoods, have fewer comorbidities and have Medicare or public (versus private) health insurance. Patients treated at NCI-CCs had higher rates of renal failure (21% vs 18%, P=0.03) and lower rates of respiratory failure (11% vs 14%, P=0.002) and sepsis (33% vs 36%, P=0.04) than those treated at non-NCI-CCs. Rates of bleeding, thrombosis, liver failure and cardiac arrest did not differ by location of care. After propensity-score weighting, baseline characteristics were balanced between patients treated at NCI-CCs versus non-NCI-CCs (all standardized mean differences <2.3%). In multivariable, inverse probability weighted models, treatment at an NCI-CC (versus non-NCI-CC) was associated with lower early mortality (OR 0.50, CI 0.42-0.59) (Table). Complications associated with higher early mortality, regardless of treatment location, included: bleeding (OR 1.91, CI 1.54-2.37), liver (OR 3.41, CI 1.91-6.09), renal (OR 2.39, CI 1.97-2.90) and respiratory (OR 6.08, CI 4.88-7.57) failure and cardiac arrest (OR 15.28, CI 8.11-27.78) (Table). The impact of complications on early mortality did not differ by location of care with the exception of respiratory failure (P for interaction=0.001); AML patients with respiratory failure had a higher odds of early mortality when treated at non-NCI-CCs (OR 8.59, CI 6.66-11.07) versus NCI-CCs (OR 4.43, CI 2.68-7.33). Other factors significantly associated with early mortality included younger age, treatment after 2002, non-Hispanic White race/ethnicity (versus African Americans, Hispanics and Asians), single marital status (versus married), residence in low socioeconomic status neighborhoods (versus high) and presence of any comorbidities (versus none). Conclusions In patients with AML, initial treatment at a NCI-CC is associated with 50% reduction in early mortality than treatment at a non-NCI-CC, adjusted for baseline socio-demographic variables, comorbidities and complications within 60 days. Lower early mortality may result from differences in supportive care practices, hospital or provider experience and access to clinical trials at NCI-CCs. Future studies should evaluate the specific differences in care at NCI-CCs to inform strategies to improve early mortality outcomes for all AML patients. Table. Table. Disclosures No relevant conflicts of interest to declare.
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Burford, C., R. Laxton, Z. Sidhu, M. Aizpurua, A. King, I. Bodi, K. Ashkan, and S. Al-Sarraj. "ATRX immunohistochemistry can help refine ‘not elsewhere classified’ categorisation for grade II/III gliomas." British Journal of Neurosurgery 33, no. 5 (April 24, 2019): 536–40. http://dx.doi.org/10.1080/02688697.2019.1600657.
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Louis, David N., Pieter Wesseling, Werner Paulus, Caterina Giannini, Tracy T. Batchelor, J. Gregory Cairncross, David Capper, et al. "cIMPACT-NOW update 1: Not Otherwise Specified (NOS) and Not Elsewhere Classified (NEC)." Acta Neuropathologica 135, no. 3 (January 25, 2018): 481–84. http://dx.doi.org/10.1007/s00401-018-1808-0.
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Bowen, Michael E., Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D. Persell, and Ethan A. Halm. "Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions." American Journal of Medical Quality 33, no. 3 (October 14, 2017): 237–45. http://dx.doi.org/10.1177/1062860617732830.
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Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before–after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.
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Gangadhar, K., and D. Santhosh. "Primary Skull Osteosarcoma: MDCT Evaluation and Histopathological Correlation in Two Cases." Neuroradiology Journal 25, no. 2 (April 2012): 188–92. http://dx.doi.org/10.1177/197140091202500206.
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Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy. We describe two cases of primary osteosarcoma of skull one presenting with cerebellar symptoms and another with giant skull swelling. Complete evaluation with 64 slice CT and histopathological correlation was carried out.
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Rotulo, Gioacchino Andrea, Blandine Beaupain, and Jean Donadieu. "ELANE Neutropenia Beyond the Classification into Cyclic Neutropenia and Severe Congenital Neutropenia: The Inconstant Time Clock." Blood 138, Supplement 1 (November 5, 2021): 986. http://dx.doi.org/10.1182/blood-2021-149759.
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Abstract Introduction: ELANE neutropenia represents the cause of 25-30% of the cases of congenital neutropenia. Classically, its appears in the literature as in OMIM, under two distinct entities: Severe congenital neutropenia (SCN) and cyclic neutropenia (CyN). The delineation between the 2 entities is the "cyclicity" i.e. the periodic variation of the absolute neutrophils count (ANC), also called a 21-day time clock 1. However, it is extremely difficult to obtain enough sequential complete blood counts (CBC) at the onset of the disease, during an enough length period, while the patient is not experiencing a severe infection or receiving GCSF therapy. The purpose of our study is to analyze the ANC periodicity at the onset of the disease, prior to the initiation of GCSF in a cohort of patients with ELANE neutropenia. Methods : Available data from the patients, with ELANE class 4 and 5 variants, enrolled in the French Severe Chronic Neutropenia Registry, were analysed. The final diagnostic of CyN and SCN was performed considering all the follow up period (median 16.7 years) and based on the presence of recurrent periodic variation of ANC in the absence of GCSF therapy. CyN was defined as multiple documented ANCs >500 cells/mm 3 , with intermittent ANC variation (n=49), while SCN is defined as ANC persistently <500 cells/mm 3 (n=94). In case of irregularity (i.e. not a regular periodic pattern during all the follow up), the classification takes in consideration the majority of the follow up. A comprehensive analysis of the infectious profile is available elsewhere 2. We were focused here on the diagnostic period (roughly the 2 first months since the diagnosis). We have analysed the initial blood count of the patients and cast the patients by categories if at least 4 ANCs can be evaluated. ANC oscillations defined 4 groups: Group 1: oscillation of ANC values above and below 500 ANC/mm 3 for at least 2 cycles lead to consider the patient as Cyclic; Group 2: clear oscillation of ANC values above and below 200 ANC/mm 3 (but ever<500 ANC/mm 3) for at least 2 cycles; Group 3: no oscillation of ANC values whose level are ever below 500 ANC/mm 3; Group 4: Early GCSF treatment. Results : Among the 143 patients enrolled in this study (Table 1), 137 have at least 4 CBC evaluable during the diagnosis period, including 30 who have been treated almost front line after diagnosis of neutropenia by GCSF hampering evaluation of periodicity. Such patients were all initially considered as SCN. Among the 67 finally classified as SCN, 28 (27.38%) showed an oscillation pattern (group 1), 14 (15.48%) showed minor oscillations (group 2), while 25 (30.95%) had a persistent and severe neutropenia (group 3). Among the 40 CyN, 1 have showed minor oscillations (group 2) below 500/mm 3, while 3 had a persistent and severe neutropenia (group 3). Globally, 32 /107 patients were miss- classified at diagnosis compare to the final diagnosis. Additional data shows that many health indicators could not be deducted from the initial classification like the infections rate, the use of GCSF, the death rate, the sequels rate. Conclusions: Periodic variation of ANC despite being the criteria to define the sub type of ELANE neutropenia is difficult to evaluate at the initial presentation of the disease. In addition, cyclicity is not a permanent feature in ELANE neutropenia, some patients being cyclic only for a certain time in their life span. It results a high rate of miss classification if we compare the initial diagnostic period and all the medical history of the patients. Noteworthy, the rate of several severe complications is not so clearly different between diagnosis sub categories. We propose to consider ELANE neutropenia as a unique disease characterized by a clinical spectrum ranging from more severe forms (corresponding to SCN) to milder forms, the latter often characterized at onset by ANC fluctuations. In addition, some intermediate severity forms could be characterized by minor oscillations. References 1 Horwitz M, Benson KF, Person RE, Aprikyan AG, Dale DC. Mutations in ELA2, encoding neutrophil elastase, define a 21-day biological clock in cyclic haematopoiesis. Nat.Genet. 1999;23:433-436. 2 Rotulo GA, Plat G, Beaupain B et al. Recurrent bacterial infections, but not fungal infections, characterise patients with ELANE-related neutropenia: a French Severe Chronic Neutropenia Registry study. Br J Haematol. 2021 doi: 10.1111/bjh.17695 Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Pridmore, Saxby, Helen Hornsby, David Hay, and Ivor Jones. "Survival Analysis and Readmission in Mood Disorder." British Journal of Psychiatry 165, no. 6 (December 1994): 824–27. http://dx.doi.org/10.1192/bjp.165.6.824.
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BackgroundThis is an exploratory study of readmission in mood disorder.MethodThe study is naturalistic and employs survival analysis. We identified 821 individuals with ICD–9 diagnoses, drawn from the Tasmanian Mental Health Register.ResultsNo demographic variables influence the time to readmission. Two groups emerge: those with affective psychoses, and those with neurotic depression, brief depressive reaction and depressive disorders not elsewhere classified. The former group demonstrated shorter times to readmission than the latter. There was no support for a unipolar–bipolar distinction.ConclusionsAffective psychoses have a less favourable outcome than expected. There was support for an endogenous-neurotic distinction.
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Kopacz, Marek S., Cathleen P. Kane, Brady Stephens, and Wilfred R. Pigeon. "Use ofICD-9-CMDiagnosis Code V62.89 (Other Psychological or Physical Stress, Not Elsewhere Classified) Following a Suicide Attempt." Psychiatric Services 67, no. 7 (July 2016): 807–10. http://dx.doi.org/10.1176/appi.ps.201500302.
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Makino, Yasuhide, Takeshi Kawauchi, Yoshiki Arakawa, Tomoko Shofuda, Ema Yoshioka, Masahiro Tanji, Yohei Mineharu, Yonehiro Kanemura, and Susumu Miyamoto. "LGG-38. GENETIC ANALYSIS OF NEUROEPITHELIAL TUMORS IN THE PEDIATRIC AND ADOLESCENT AND YOUNG ADULT AGE IN A SINGLE INSTITUTE." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii373—iii374. http://dx.doi.org/10.1093/neuonc/noaa222.419.
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Abstract Molecular diagnosis in brain tumors has been widely spread after the publication of WHO 2016 classification. But it become a major problem that there are some tumors not to be classified on its criteria, especially in pediatric neuroepithelial tumors. To clarify the characteristics of gliomas in pediatric and adolescent and young adult age (AYA), we picked up 131 neuroepithelial tumors under 30-year-old at Kyoto University and analyze their molecular profiles. Hot spot mutations in IDH1/2, H3F3A, HIST1H3B, TERT promoter, and BRAF were analyzed by Sanger sequencing, and 1p/19q codeletion was examined by FISH or MLPA. With the pathohistological diagnosis and genetic information, all tumors were classified based on WHO 2016 classification. The terms “not otherwise specified” (NOS) and “not elsewhere classified” (NEC) were used based on cIMPACT-NOW. There were 25 glioblastomas and 34 pilocytic astrocytomas, which accounted for a larger percentage than in adult tumors. IDH-wild type gliomas accounted for 55% in diffuse astrocytomas and 69% in anaplastic astrocytomas. The percentages of gliomas with NEC were 50% of oligodendrogliomas and 20% in anaplastic oligodendrogliomas, respectively. Most pilocytic astrocytomas were under 20-year-old (27 patients) and located in infratentorial area (21 patients). Based on WHO 2016 classification, not a few neuroepithelial tumors in pediatric and AYA ages could be classified clearly. These tumors had more different genetic abnormalities than those in adult. Therefore, it may be important to evaluate these tumors with comprehensive genetic analysis.
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Sweeney, Vincent P., Adele D. Sadovnick, and Vilma Brandejs. "Prevalence of Multiple Sclerosis in British Columbia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 13, no. 1 (February 1986): 47–51. http://dx.doi.org/10.1017/s0317167100035782.
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ABSTRACT:A province wide prevalence study on multiple sclerosis (MS) was conducted in British Columbia (B.C.). The prevalence date was July 1, 1982. The major portion of this study was a review of all the files of neurologists practicing in B.C. as this was judged to be the most accurate source for identifying MS patients. 239,412 neurologists' files were hand searched by one researcher using modified Schumacher criteria for classification. Other sources used during the study for identifying MS patients were the MS Clinic, general practitioners, ophthalmologists, urologists, specialized facilities such as long term care facilities and rehabilitation centres, and patient self-referrals.A total of 4,620 non-duplicated cases were identified and classified. 4,112 of these (89%) were classified according to information contained in neurologists' records.The prevalence estimate for definite/probable MS in B.C. was 93.3/100,000 population. This increased to 130.5/100,000 population if possible MS and optic neuritis were also included. These rates are among the highest reported in Canada or elsewhere. The cooperation of B.C. neurologists made this study unique in its scope and accuracy of diagnosis.
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Cimino, J. J. "Desiderata for Controlled Medical Vocabularies in the Twenty-First Century." Methods of Information in Medicine 37, no. 04/05 (October 1998): 394–403. http://dx.doi.org/10.1055/s-0038-1634558.
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AbstractBuilders of medical informatics applications need controlled medical vocabularies to support their applications and it is to their advantage to use available standards. In order to do so, however, these standards need to address the requirements of their intended users. Overthe past decade, medical informatics researchers have begun to articulate some of these requirements. This paper brings together some of the common themes which have been described, including: vocabulary content, concept orientation, concept permanence, nonsemantic concept identifiers, polyhierarchy, formal definitions, rejection of “not elsewhere classified” terms, multiple granularities, mUltiple consistent views, context representation, graceful evolution, and recognized redundancy. Standards developers are beginning to recognize and address these desiderata and adapt their offerings to meet them.
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Gardner, R. "Guidelines on the clinical management of suicidal patients in psychiatric units." Psychiatric Bulletin 13, no. 10 (October 1989): 561–64. http://dx.doi.org/10.1192/pb.13.10.561.
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Views differ as to whether it is feasible – or indeed desirable – to agree on a Code of Practice with respect to the clinical management of suicidal patients in psychiatric units (Morgan, 1988). At Fulbourn Hospital (Gardner, 1988) we have developed some guidelines which might, if suitably modified, be used elsewhere; they are appended below.
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el-Yazigi, A., K. Chaleby, and C. R. Martin. "A simplified and rapid test for acetylator phenotyping by use of the peak height ratio of two urinary caffeine metabolites." Clinical Chemistry 35, no. 5 (May 1, 1989): 848–51. http://dx.doi.org/10.1093/clinchem/35.5.848.
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Abstract We describe a simplified liquid-chromatographic test in which acetylator phenotype is determined by measuring the peak height ratio of two urinary caffeine metabolites, 5-acetylamino-6-formylamino-3-methyluracil and 1-methylxanthine. We applied this test to determine the acetylator phenotypes of 52 subjects who regularly drink coffee, tea, or caffeinated beverages. Also, we determined the acetylator phenotypes of these subjects according to a well-established sulfasalazine test, which yielded identical results. We established the reproducibility of the described test by determining the acetylator phenotypes of 10 additional subjects on two different days separated by a period of two to five weeks. Of the 52 subjects examined by both tests, 40 (76.9%) were classified as slow acetylators, which agrees well with the percentage reported elsewhere for 297 similar subjects from the Saudi population.
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Gruebner, Oliver, Wenjia Wei, Agne Ulyte, Viktor von Wyl, Holger Dressel, Beat Brüngger, Caroline Bähler, Eva Blozik, and Matthias Schwenkglenks. "Small Area Variation of Adherence to Clinical Recommendations: An Example from Switzerland." Health Services Research and Managerial Epidemiology 9 (January 2022): 233339282210977. http://dx.doi.org/10.1177/23333928221097741.
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Background Unwarranted variation in healthcare utilization can only partly be explained by variation in the health care needs of the population, yet it is frequently found globally. This is the first cross-sectional study that systematically assessed geographic variation in the adherence to clinical recommendations in Switzerland. Specifically, we explored 1) the geographic variation of adherence to clinical recommendations across 24 health services at the sub-cantonal level, 2) assessed and mapped statistically significant spatial clusters, and 3) explored possible influencing factors for the observed geographic variation. Methods Exploratory spatial analysis using the Moran’s I statistic on multivariable multilevel model residuals to systematically identify small area variation of adherence to clinical recommendations across 24 health services. Results Although there was no overall spatial pattern in adherence to clinical recommendations across all health care services, we identified health services that exhibited statistically significant spatial dependence in adherence. For these, we provided evidence about the locations of local clusters. Interpretation We identified regions in Switzerland in which specific recommended or discouraged health care services are utilized less or more than elsewhere. Future studies are needed to investigate the place-based social determinants of health responsible for the sub-cantonal variation in adherence to clinical recommendations in Switzerland and elsewhere over time.
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Girnius, Saulius K., Habte A. Yimer, Stephen J. Noga, Sudhir Manda, Roger M. Lyons, Kimberly Bogard, Presley Whidden, et al. "In-Class Transition (iCT) from Parenteral Bortezomib to Oral Ixazomib Proteasome Inhibitor (PI) Therapy Increases the Feasibility of Long-Term PI Treatment and Benefit for Newly Diagnosed Multiple Myeloma (NDMM) Patients in an Outpatient Setting: Updated Real-World Results from the Community-Based United States (US) MM-6 Study." Blood 136, Supplement 1 (November 5, 2020): 2–4. http://dx.doi.org/10.1182/blood-2020-140482.
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Background Long-term PI-based treatment is associated with improved outcomes in MM. Nonetheless, prolonged therapy with parenteral PIs (e.g. bortezomib) can be challenging in the real world, with median duration of therapy (DOT) of 4-7 months. Barriers to this long-term approach may include the burden of repeated intravenous/subcutaneous administration, difficulty travelling to/accessing treatment centers (e.g. due to environmental factors, travel restrictions, social/family situations), patient preference for treatment outside of a hospital or clinic setting, comorbidities, and toxicity. The US MM-6 study (NCT03173092) is investigating in-class transition (iCT) from parenteral bortezomib-based induction to all-oral ixazomib-based therapy (ixazomib-lenalidomide-dexamethasone; IRd) in the diverse US community population with the aim of increasing PI-based treatment duration while maintaining quality of life and improving outcomes. We report updated efficacy and safety for the first 101 patients. Methods Transplant-ineligible/delayed-transplant (>24 months) NDMM patients with stable disease or better after 3 cycles of bortezomib-based induction are being enrolled at US community sites (including Veterans Affairs hospitals) to receive IRd (ixazomib 4 mg, days 1, 8, 15; lenalidomide 25 mg, days 1-21; dexamethasone 40 mg, days 1, 8, 15, 22) for up to 39 x 28-day cycles or until progression/toxicity. The primary endpoint is progression-free survival (PFS); key secondary endpoints include rates of partial (PR), very good PR (VGPR), and complete response (CR), and DOT. Results As of June 1 2020, 101 patients had been treated at 21 sites. Median age was 73 years (range 48-90), with 46% aged ≥75 years; 16% and 10% were of African American and Hispanic ethnicity, respectively. Table 1 summarizes the key characteristics of these real-world patients. A total of 95% of patients had ≥1 comorbidity at the start of IRd therapy including renal and urinary disorders (38%), cardiac disorders (29%), peripheral neuropathy (PN; 14%), and diabetes mellitus (13%) (Table 2). With 53 (52%) patients remaining on therapy and enrollment ongoing, mean duration of PI therapy from the start of bortezomib-based induction was 12.4 months, and mean duration of IRd therapy after iCT was 9.2 months (Table 3). Patients have received up to 29.4 months (31 cycles) of IRd to date. The overall response rate (ORR) after bortezomib-based induction was 62% (7% CR, 32% ≥VGPR). After iCT to IRd, the ORR increased to 71%, with the CR and ≥VGPR rates increasing to 29% and 53%, respectively (Figure); of 33 patients with stable disease following bortezomib-based induction, 14 (42%) achieved CR (n=10) or VGPR (n=4) after iCT. With a median follow-up of 12 months and enrollment ongoing, 13 patients had progressed and two had died during PFS analysis. The 12-month PFS rate was 84% (95% CI, 73-91) from the start of bortezomib-based induction and 80% (95% CI, 69-88) from the start of IRd. During IRd treatment to date, 91% of patients have had treatment-emergent adverse events (TEAEs) (54% grade ≥3). Grade 3 TEAEs (≥5% of patients) were diarrhea (8%), pneumonia (7%), and syncope (5%). TEAEs led to study drug modification in 52% of patients and discontinuation in 7% of patients; 37% had serious TEAEs. Diarrhea, nausea, and vomiting occurred in 43%, 23%, and 14% of patients (8%, 2%, 2% grade 3), and led to dose modification in 11%, 5%, and 2%. PN (not elsewhere classified; high-level term) occurred in 32% of patients (2% grade 3) and led to dose modification in 9%. There were three on-study deaths (i.e. occurring <30 days after last dose). Conclusions US MM-6 patients reflect the heterogeneous real-world US MM population; the population for this study includes patients from the community who may not be eligible for traditional clinical trials. These updated data in mostly elderly, comorbid, NDMM patients treated in the community setting demonstrate the feasibility and tolerability of iCT to IRd after 3 cycles of bortezomib-based induction; approximately half of patients remain on treatment, and enrollment is ongoing. iCT to IRd resulted in improved responses, with increased rates of ≥VGPR, and prolonged DOT and may thereby improve outcomes for real-world patients. iCT to an all oral regimen could also prevent treatment interruptions for patients who are unable to or prefer not to travel in the context of travel restrictions or other factors. Disclosures Girnius: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Yimer:TG Therapeutics: Consultancy; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Sanofi: Speakers Bureau; Texas Oncology: Current Employment; BeiGene: Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Janssen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Celgene, a Bristol-Myers Squibb Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Karyopharm: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Epizyme: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months. Noga:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Manda:AbbVie: Other: Investigator in AbbVie-sponsored clinical trials. Lyons:Texas Oncology/US Oncology: Current Employment; Novartis: Honoraria. Bogard:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Whidden:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Cherepanov:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Lu:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Aiello:Takeda: Honoraria; Travera: Honoraria; Celgene: Honoraria; Karyopharm: Honoraria. Richter:Celgene: Consultancy, Speakers Bureau; Adaptive Biotechnologies: Consultancy, Speakers Bureau; Janssen: Speakers Bureau; Sanofi: Consultancy; Karyopharm: Consultancy; Takeda: Consultancy; AstraZeneca: Consultancy; Secura Bio: Consultancy; Bristol Myers Squibb: Consultancy; X4 Pharmaceuticals: Consultancy; Oncopeptides: Consultancy; Antengene: Consultancy. Rifkin:McKesson: Current equity holder in publicly-traded company, Ended employment in the past 24 months, Other: Stock ownership; Takeda, Amgen, Celgene, BMS, Mylan, Coherus BioSciences, Fresenius: Consultancy; AbbVie: Other: Investigator in AbbVie sponsored clinical trials; Takeda, Amgen, BMS (Celgene): Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: Real-world evaluation of long-term proteasome inhibition with ixazomib in combination with lenalidomide and dexamethasone for the treatment of newly diagnosed multiple myeloma in non-transplant patients with stable disease after 3 cycles of a bortezomib-based induction.
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Masaki, Motofumi, and Akira Koizumi. "Demographic characteristics and their genetic implications in a small island." Journal of Biosocial Science 20, no. 2 (April 1988): 225–34. http://dx.doi.org/10.1017/s0021932000017454.
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SummaryThe family registration records from a village population in a small island of Japan are used to assess the effect of demographic differentiation within a population on genetic measures. When the couples studied are classified by birth cohorts and origins, wives of the couples where one spouse came from elsewhere were older at marriage and had a shorter duration of marriage or registration than wives where both spouses were natives of the village. The mean number of offspring is statistically smaller in the former except for the latest cohort, due mainly to out-migration during the reproductive ages which also resulted in low rates of marriage among the offspring within the village. This leads to a small effective population size and an increased likelihood of genetic drift in the overall population.
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Sinkin, Robert A., Christopher Cox, and Dale L. Phelps. "Predicting Risk for Bronchopulmonary Dysplasia: Selection Criteria for Clinical Trials." Pediatrics 86, no. 5 (November 1, 1990): 728–36. http://dx.doi.org/10.1542/peds.86.5.728.
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Early identification of neonates in whom bronchopulmonary dysplasia is most likely to develop permits appropriate enrollment into clinical trials testing early intervention therapies for the prevention or treatment of bronchopulmonary dysplasia. Analysis of 160 neonatal intensive care unit survivors to 28 days revealed that supplemental oxygen requirement at 28 days could be predicted by a logistic regression including (1) birth weight, gestational age, 5-minute Apgar score, and peak inspiratory pressure at 12 hours for 12-hour-old neonates and (2) birth weight, gestational age, peak inspiratory pressure at 12 hours, and mean airway pressure at 10 days for 10-day-old neonates. These two regression analyses were applied prospectively to three new data sets totaling 238 neonates to test their predictive ability. Neonates were classified into low-, moderate-, or high-risk groups on the basis of their predicted probability of requiring oxygen supplementation at 28 days; low = probability of <25%, moderate = probability of 25% to 75%, and high = probability >75%. Although these populations were demographically distinct from the original group, the regression analyses performed well. The regression analysis for 12 hours of age classified 125 neonates at low risk of whom 9% required supplemental oxygen at 28 days, and the regression analysis for 10 days classified 141 neonates at low risk of whom 7% required supplemental oxygen. The 12-hour regression analysis classified 80 neonates at moderate risk of whom 33% required supplemental oxygen at 28 days and the 10-day regression analysis classified 49 neonates at moderate risk of whom 24% required supplemental oxygen. The 12-hour regression analysis classified 33 neonates at high risk of whom 64% required supplemental oxygen, and the 10-day regression analysis classified 48 neonates at high risk of whom 75% required supplemental oxygen. A graphic presentation of these two regression analyses permits easy bedside prediction of a neonate's risk of requiring supplemental oxygen at 28 days at the time of enrollment for clinical preventive or therapeutic trials for bronchopulmonary dysplasia and facilitates the calculation of required sample sizes.
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Cowan, Frances. "Which Neurological Examinations can be used to Predict Outcome During the Neonatal Period?" International Journal of Technology Assessment in Health Care 7, S1 (January 1991): 118–24. http://dx.doi.org/10.1017/s0266462300012630.
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In this review I shall discuss the prognostic value of the clinical neurological examination, the EEG (and the various methods of recording it), evoked responses, and Doppler ultrasound measurements of cerebral blood velocity. Imaging modalities (ultrasound, CT, MRI) will be dealt with elsewhere under discussion of their diagnostic value.
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Feng, Shuxian, and Toshiya Yamamoto. "Preliminary research on sponge city concept for urban flood reduction: a case study on ten sponge city pilot projects in Shanghai, China." Disaster Prevention and Management: An International Journal 29, no. 6 (November 9, 2020): 961–85. http://dx.doi.org/10.1108/dpm-01-2020-0019.
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PurposeThis research aimed to determine the differences and similarities in each pilot project to understand the primary design forms and concepts of sponge city concept (SCC) projects in China. It also aimed to examine ten pilot projects in Shanghai to extrapolate their main characteristics and the processes necessary for implementing SCC projects effectively.Design/methodology/approachA literature review and field survey case study were employed. Data were mostly collected through a field survey in Shanghai, focusing on both the projects and the surrounding environment. Based on these projects' examination, a comparative method was used to determine the characteristics of the ten pilot SCC projects and programs in Shanghai.FindingsSix main types of SCC projects among 30 pilot cities were classified in this research to find differences and similarities among the pilot cities. Four sponge design methods were classified into ten pilot projects. After comparing each project size using the same geographical size, three geometrical types were categorized into both existing and new city areas. SCC project characteristics could be identified by combining four methods and three geometrical types and those of the SCC programs by comparing the change in land-use and the surrounding environment in ten pilot projects.Originality/valueThe results are valuable for implementing SCC projects in China and elsewhere and future research on the impact of SCC projects.
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Chamberlain, Samuel R., Katherine Derbyshire, Richard E. Daws, Brian L. Odlaug, Eric W. Leppink, and Jon E. Grant. "White matter tract integrity in treatment-resistant gambling disorder." British Journal of Psychiatry 208, no. 6 (June 2016): 579–84. http://dx.doi.org/10.1192/bjp.bp.115.165506.
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BackgroundGambling disorder is a relatively common psychiatric disorder recently re-classified within the DSM-5 under the category of ‘substance-related and addictive disorders'.AimsTo compare white matter integrity in patients with gambling disorder with healthy controls; to explore relationships between white matter integrity and disease severity in gambling disorder.MethodIn total, 16 participants with treatment-resistant gambling disorder and 15 healthy controls underwent magnetic resonance imaging (MRI). White matter integrity was analysed using tract-based spatial statistics.ResultsGambling disorder was associated with reduced fractional anisotropy in the corpus callosum and superior longitudinal fasciculus. Fractional anisotropy in distributed white matter tracts elsewhere correlated positively with disease severity.ConclusionsReduced corpus callosum fractional anisotropy is suggestive of disorganised/damaged tracts in patients with gambling disorder, and this may represent a trait/vulnerability marker for the disorder. Future research should explore these measures in a larger sample, ideally incorporating a range of imaging markers (for example functional MRI) and enrolling unaffected first-degree relatives of patients.
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De Carlo, D., L. Dal Zotto, E. Perissinotto, L. Gallo, M. Gatta, U. Balottin, G. Mazzotta, et al. "Osmophobia in migraine classification: A multicentre study in juvenile patients." Cephalalgia 30, no. 12 (March 26, 2010): 1486–94. http://dx.doi.org/10.1177/0333102410362928.
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Aims: This study was planned to investigate the diagnostic utility of osmophobia as criterion for migraine without aura (MO) as proposed in the Appendix (A1.1) of the International Classification of Headache Disorders (ICHD-II, 2004). Methods: We analysed 1020 patients presenting at 10 Italian juvenile headache centres, 622 affected by migraine (M) and 328 by tension-type headache (TTH); 70 were affected by headache not elsewhere classified (NEC) in ICHD-II. By using a semi-structured questionnaire, the prevalence of osmophobia was 26.9%, significantly higher in M than TTH patients (34.6% vs 14.3%). Results: Osmophobia was correlated with: (i) family history of M and osmophobia; and (ii) other accompanying symptoms of M. By applying these ‘new’ criteria, we found an agreement with the current criteria for the diagnosis of migraine without aura (MO) in 96.2% of cases; 54.3% of previously unclassifiable patients received a ‘new’ diagnosis. Conclusions: In conclusion, this study demonstrates that this new approach, proposed in the Appendix (A1.1), appears easy to apply and should improve the diagnostic standard of ICHD-II in young patients too.
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Ruiz Jr, Facundo Burgos, Márcia Silva Santos, Helen Souto Siqueira, and Ulisses Correa Cotta. "Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence?" Arquivos de Neuro-Psiquiatria 65, no. 4b (December 2007): 1130–33. http://dx.doi.org/10.1590/s0004-282x2007000700007.
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In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.
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Ba, Hampate, Sarah Auburn, Christopher G. Jacob, Sonia Goncalves, Craig W. Duffy, Lindsay B. Stewart, Ric N. Price, et al. "Multi-locus genotyping reveals established endemicity of a geographically distinct Plasmodium vivax population in Mauritania, West Africa." PLOS Neglected Tropical Diseases 14, no. 12 (December 16, 2020): e0008945. http://dx.doi.org/10.1371/journal.pntd.0008945.
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Background Plasmodium vivax has been recently discovered as a significant cause of malaria in Mauritania, although very rare elsewhere in West Africa. It has not been known if this is a recently introduced or locally remnant parasite population, nor whether the genetic structure reflects epidemic or endemic transmission. Methodology/Principal findings To investigate the P. vivax population genetic structure in Mauritania and compare with populations previously analysed elsewhere, multi-locus genotyping was undertaken on 100 clinical isolates, using a genome-wide panel of 38 single nucleotide polymorphisms (SNPs), plus seven SNPs in drug resistance genes. The Mauritanian P. vivax population is shown to be genetically diverse and divergent from populations elsewhere, indicated consistently by genetic distance matrix analysis, principal components analyses, and fixation indices. Only one isolate had a genotype clearly indicating recent importation, from a southeast Asian source. There was no linkage disequilibrium in the local parasite population, and only a small number of infections appeared to be closely genetically related, indicating that there is ongoing genetic recombination consistent with endemic transmission. The P. vivax diversity in a remote mining town was similar to that in the capital Nouakchott, with no indication of local substructure or of epidemic population structure. Drug resistance alleles were virtually absent in Mauritania, in contrast with P. vivax in other areas of the world. Conclusions/Significance The molecular epidemiology indicates that there is long-standing endemic transmission that will be very challenging to eliminate. The virtual absence of drug resistance alleles suggests that most infections have been untreated, and that this endemic infection has been more neglected in comparison to P. vivax elsewhere.
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Huxley, Peter, Hitesh Raval, Jacky Korer, and Caroline Jacob. "Psychiatric morbidity in the clients of social workers: clinical outcome." Psychological Medicine 19, no. 1 (February 1989): 189–97. http://dx.doi.org/10.1017/s0033291700011144.
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SynopsisOut of 141 new referrals to a Social Services Department 101 were assessed at inception and twelve-month follow-up using the Present State Examination (PSE), the Social Maladjustment Schedule (SMS) and the Case Review Form (CRF). Mental illness, financial and housing problems were the three problems most frequently identified by the social workers. At inception 72 (51%) of the subjects were PSE cases (ID > 5) and 25% at follow-up. The type of social work help offered to cases and non-cases did not differ.Social and clinical data collected at inception and follow-up were used to classify (using discriminant function analysis) caseness at inception and follow-up and clinical change. Caseness at inception (82% of subjects were correctly classified) was associated with depression, subjective social problems and poverty. Caseness at follow-up (74% correctly classified) was associated with poor coping abilities at inception and clinical features of depression. Clinical change (worsening) (71% correctly classified) was associated with seeing a Community Psychiatric Nurse and poor coping abilities at inception. The ability to classify correctly cases and change was enhanced when additional data from follow-up interviews were used. In the PSE cases, only clinical worsening was correctly classified by a high GHQ score at inception, age and poor coping abilities. The last result is similar to that obtained in general practice by Mann et al. (1981).
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Papageorgiou, G., F. Cañas, M. Zink, and A. Rossi. "Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe." European Psychiatry 26, S1 (March 2011): 17–28. http://dx.doi.org/10.1016/s0924-9338(11)71710-2.
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AbstractSchizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.
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Dixon, Simon, Pat Coleman, Jon Nicholl, Alan Brennan, and Sandra Touch. "Evaluation of the Impact of a Technology Appraisal Process in England: The South and West Development and Evaluation Committee." Journal of Health Services Research & Policy 8, no. 1 (January 2003): 18–24. http://dx.doi.org/10.1177/135581960300800106.
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Objectives: To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. Methods: Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data. Results: Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been £24 659. Conclusions: Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.
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Doran, Evan, Jennifer Fleming, Christopher Jordens, Cameron L. Stewart, Julie Letts, and Ian H. Kerridge. "Managing ethical issues in patient care and the need for clinical ethics support." Australian Health Review 39, no. 1 (2015): 44. http://dx.doi.org/10.1071/ah14034.
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Objective To investigate the range, frequency and management of ethical issues encountered by clinicians working in hospitals in New South Wales (NSW), Australia. Methods A cross-sectional survey was conducted of a convenience sample of 104 medical, nursing and allied health professionals in two NSW hospitals. Results Some respondents did not provide data for some questions, therefore the denominator is less than 105 for some items. Sixty-two (62/104; 60%) respondents reported occasionally to often having ethical concerns. Forty-six (46/105; 44%) reported often to occasionally having legal concerns. The three most common responses to concerns were: talking to colleagues (96/105; 91%); raising the issue in a group forum (68/105; 65%); and consulting a relevant guideline (64/105; 61%). Most respondents were highly (65/99; 66%) or moderately (33/99; 33%) satisfied with the ethical environment of the hospital. Twenty-two (22/98; 22%) were highly satisfied with the ethical environment of their department and 74 (74/98; 76%) were moderately satisfied. Most (72/105; 69%) respondents indicated that additional support in dealing with ethical issues would be helpful. Conclusion Clinicians reported frequently experiencing ethical and legal uncertainty and concern. They usually managed this by talking with colleagues. Although this approach was considered adequate, and the ethics of their hospital was reported to be satisfactory, most respondents indicated that additional assistance with ethical and legal concerns would be helpful. Clinical ethics support should be a priority of public hospitals in NSW and elsewhere in Australia. What is known about the topic? Clinicians working in hospitals in the US, Canada and UK have access to ethics expertise to help them manage ethical issues that arise in patient care. How Australian clinicians currently manage the ethical issues they face has not been investigated. What does this paper add? This paper describes the types of ethical issues faced by Australian clinicians, how they manage these issues and whether they think ethics support would be helpful. What are the implications for practitioners? Clinicians frequently encounter ethically and legally difficult decisions and want additional ethics support. Helping clinicians to provide ethically sound patient care should be a priority of public hospitals in NSW and elsewhere in Australia.
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Rehm, Jürgen, Mindaugas Štelemėkas, Carina Ferreira-Borges, Huan Jiang, Shannon Lange, Maria Neufeld, Robin Room, Sally Casswell, Alexander Tran, and Jakob Manthey. "Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000–2019." International Journal of Environmental Research and Public Health 18, no. 5 (March 2, 2021): 2419. http://dx.doi.org/10.3390/ijerph18052419.
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Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.
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Tonkin, Roger. "Camp Elsewhere: A Summer Program for Adolescents with Eating Disorders." Clinical Child Psychology and Psychiatry 1, no. 4 (October 1996): 597–606. http://dx.doi.org/10.1177/1359104596014011.
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