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Jackson, Michael, Marta Szczepaniak, Jasmine Wall, Mark Maskery, Catherine Mummery, Paul Morrish, Adrian Williams, Joanne Knight, and Hedley C. A. Emsley. "Numbers and types of neurological emergencies in England and the influence of socioeconomic deprivation: a retrospective analysis of hospital episode statistics data." BMJ Open 12, no. 11 (November 2022): e061843. http://dx.doi.org/10.1136/bmjopen-2022-061843.
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ObjectivesIn this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the care of a neurologist or neurosurgeon and how such admissions vary by levels of deprivation.DesignRetrospective empirical research employing a derived list of neurological emergency diagnostic codesSettingThis study used the Hospital Episode Statistics data set for the financial year 2019/2020 based on 17 million in-year inpatient admissions in England including 6.5 million (100%) emergency admissions with any diagnosis codes.ResultsThere were 1.4 million (21.2%) emergency inpatient admissions with a mention of any neurological code, approx. 248 455 (3.8%) with mention of a specific neurological emergency code from the derived list, and 72 485 (1.1%) included such a code as the primary reason for admission. The highest number of in-year admissions for adults was for epilepsy (145 995), with epilepsy as the primary diagnostic code in 15 945 (10.9%). Acute nerve root/spinal cord syndrome (41 215), head injury (29 235) and subarachnoid haemorrhage (18 505) accounted for the next three highest number of admissions. 3230 (1.4%) in-year emergency hospital admissions with mention of a neurological emergency code were under the care of a neurologist or neurosurgeon, with only 1315 (0.9%) admissions with mention of an epilepsy code under a neurologist. There was significant variation for epilepsy and functional neurological disorders (FNDs) in particular by Index of Multiple Deprivation decile. The association between deprivation and epilepsy and FND was significant with p-values of 2.5e-6 and 1.5e-8, respectively.ConclusionsThis study has identified important findings in relation to the burden of neurological emergency admissions but further work is needed, with greater clinical engagement in diagnostic coding, to better understand the implications for workforce and changes to service delivery needing to be implemented.
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Tsumoto, Shusaku, Shoji Hirano, Tomohiro Kimura, and Haruko Iwata. "Mining Clinical Process from Hospital Information System: A Granular Computing Approach." Fundamenta Informaticae 182, no. 2 (September 30, 2021): 181–218. http://dx.doi.org/10.3233/fi-2021-2070.
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Data mining methods in medicine is a very important tool for developing automated decision support systems. However, since information granularity of disease codes used in hospital information system is coarser than that of real clinical definitions of diseases and their treatment, automated data curation is needed to extract knowledge useful for clinical decision making. This paper proposes automated construction of clinical process plan from nursing order histories and discharge summaries stored in hospital information system with curation of disease codes as follows. First, the system applies EM clustering to estimate subgrouping of a given disease code from clinical cases. Second, it decomposes the original datasets into datasets of subgroups by using granular homogenization. Thirdly, clinical pathway generation method is applied to the datasets. Fourthly, classification models of subgroups are constructed by using the analysis of discharge summaries to capture the meaning of each subgroup. Finally, the clinical pathway of a given disease code is output as the combination of the classifiers of subgroups and the the pathways of the corresponding subgroups. The proposed method was evaluated on the datasets extracted hospital information system in Shimane University Hosptial. The obtained results show that more plausible clinical pathways were obtained, compared with previously introduced methods.
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Denburg, Michelle R., Hanieh Razzaghi, L. Charles Bailey, Danielle E. Soranno, Ari H. Pollack, Vikas R. Dharnidharka, Mark M. Mitsnefes, et al. "Using Electronic Health Record Data to Rapidly Identify Children with Glomerular Disease for Clinical Research." Journal of the American Society of Nephrology 30, no. 12 (November 15, 2019): 2427–35. http://dx.doi.org/10.1681/asn.2019040365.
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BackgroundThe rarity of pediatric glomerular disease makes it difficult to identify sufficient numbers of participants for clinical trials. This leaves limited data to guide improvements in care for these patients.MethodsThe authors developed and tested an electronic health record (EHR) algorithm to identify children with glomerular disease. We used EHR data from 231 patients with glomerular disorders at a single center to develop a computerized algorithm comprising diagnosis, kidney biopsy, and transplant procedure codes. The algorithm was tested using PEDSnet, a national network of eight children’s hospitals with data on >6.5 million children. Patients with three or more nephrologist encounters (n=55,560) not meeting the computable phenotype definition of glomerular disease were defined as nonglomerular cases. A reviewer blinded to case status used a standardized form to review random samples of cases (n=800) and nonglomerular cases (n=798).ResultsThe final algorithm consisted of two or more diagnosis codes from a qualifying list or one diagnosis code and a pretransplant biopsy. Performance characteristics among the population with three or more nephrology encounters were sensitivity, 96% (95% CI, 94% to 97%); specificity, 93% (95% CI, 91% to 94%); positive predictive value (PPV), 89% (95% CI, 86% to 91%); negative predictive value, 97% (95% CI, 96% to 98%); and area under the receiver operating characteristics curve, 94% (95% CI, 93% to 95%). Requiring that the sum of nephrotic syndrome diagnosis codes exceed that of glomerulonephritis codes identified children with nephrotic syndrome or biopsy-based minimal change nephropathy, FSGS, or membranous nephropathy, with 94% sensitivity and 92% PPV. The algorithm identified 6657 children with glomerular disease across PEDSnet, ≥50% of whom were seen within 18 months.ConclusionsThe authors developed an EHR-based algorithm and demonstrated that it had excellent classification accuracy across PEDSnet. This tool may enable faster identification of cohorts of pediatric patients with glomerular disease for observational or prospective studies.
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Petrini, Carlo. "Will medically-assisted suicide mean the rebirth of (clinical) ethics committees in Italy?" Medico-Legal Journal 88, no. 1_suppl (June 12, 2020): 26–30. http://dx.doi.org/10.1177/0025817220923650.
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The Italian Constitutional Court has held that, in certain specific circumstances, prosecution for assisted suicide, regulated by Article 580 of the Criminal Code, is not compatible with the Constitution. The circumstances in question relate to individuals who are being kept alive by life-sustaining treatments, who are fully capable of taking free, informed decisions and are suffering from irreversible conditions that are a source of intolerable physical or mental suffering. The Court has held that the Ethics Committees must assess a request for assisted suicide made by an individual meeting these conditions. The decision requires the identification of the Ethics Committee authorised to issue authorisation in such cases and a guarantee that these Ethics Committees are able to deal with this type of issue. The Court’s decision is an important opportunity to establish and promote clinical Ethics Committees, which are not nationally regulated in Italy and exist in very small numbers in only a few parts of the country.
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Liu, On Ying, Theodore Malmstrom, Patricia Burhanna, and Miriam B. Rodin. "The Evolution of an Inpatient Palliative Care Consultation Service in an Urban Teaching Hospital." American Journal of Hospice and Palliative Medicine® 34, no. 1 (July 11, 2016): 47–52. http://dx.doi.org/10.1177/1049909115610077.
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Background: Research on inpatient palliative medicine reports quality-of-life outcomes and selected “hard” outcomes including pain scores, survival, and readmissions. Objective: This case study reports the evolution of an inpatient palliative consultation (IPC) team to show how IPC induces culture change in a hospital that previously had no palliative care. Design: Retrospective chart review. Setting: A Catholic university-affiliated, inner-city hospital. Population: A total of 1700 consecutive adult inpatients from May 2009 to October 2013. Measures: Consultation records enumerated demographics, code status, powers of attorney, referring physician, reason for consultation, and discharge destination. Deidentified data were uploaded to a spreadsheet. Simple descriptive statistics were calculated. Results: Requests originated from internal medicine (24%), geriatrics (21%), neurology (including stroke and neurosurgery, 14.3%), medical intensive care unit (MICU, 12.2%), and hematology–oncology (10.3%). The MICU consults increased 17.6% over time. The numbers of consults nearly doubled after trainees began rounding with the service. Hospice discharges increased by 9.2%. Palliative management of in-hospital expirations increased 2- to 3-fold. The most common consultation requests were for pain and nonpain symptoms, establishing goals of care for patients experiencing clinical decline and convening family meetings in cases of divided judgment. Conclusion: We describe the evolution of palliative care in a safety-net hospital. Medicine services which are largely resident run adopted early. Specialty services that are attending driven adopted later. We believe house staff and nurses were the initial change agents. The number of consultations increased when house staff and students began rotating on the service suggesting unmet demand due to the limited supply of providers.
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Lam, Ching-Wan. "PrimeIndel: Four-prime-number genetic code for indel decryption and sequence read alignment." Clinica Chimica Acta 436 (September 2014): 1–4. http://dx.doi.org/10.1016/j.cca.2014.04.006.
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Wu, Ta-Peng, Cheng-Hung Tsai, Yu-Ting Su, Chu-Chiao Wang, Tzeng-Ji Chen, Ching-Mao Chang, and Fang-Pey Chen. "The Evaluation of Professional Divisions of Traditional Chinese Medicine in Taiwan through Patient Visit Records of 2012." International Journal of Environmental Research and Public Health 15, no. 9 (September 13, 2018): 1992. http://dx.doi.org/10.3390/ijerph15091992.
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For decades, professional divisions have been represented as the main structural divisions in Western medicine throughout the world. In Taiwan, medical policymakers are also interested in designing professional divisions of traditional Chinese medicine (TCM). Therefore, this study evaluated the current status and potentiality of professional divisions of TCM in Taiwan using data from the year 2012 obtained from the National Health Insurance Research Database; the database provides information regarding age and gender of TCM physicians (TCMPs); total visit counts; contracted medical institution codes; groupings of diseases classified under International Classification of Diseases, Ninth Revision, Clinical Modification codes; numbers of children and female patients seeking treatment; and claim disposition codes used by each TCMP. The results indicated that there were 5522 TCMPs in 2012, and 4876 (90.3%) TCMPs practiced in primary clinics. The proportions of pediatric visits to these TCMPs were mostly below 0.2, and acupuncture or traumatology-related visit proportions were below 0.5. Only a few of the studied Taiwan-based TCMPs practiced gynecology and pediatrics, but most of them performed “internal medicine”, or “acupuncture” or “traumatology” treatments. Thus, the number of TCM specialists practicing gynecology or pediatrics is insufficient, indicating that a policy that forms professional divisions of TCM practitioners in Taiwan should be reconsidered.
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Jeong, Yunjin, Haewook Jang, Junwon Kang, Juhong Nam, Kyoungseob Shin, Sunghoon Kwon, and Jungil Choi. "Color-Coded Droplets and Microscopic Image Analysis for Multiplexed Antibiotic Susceptibility Testing." Biosensors 11, no. 8 (August 19, 2021): 283. http://dx.doi.org/10.3390/bios11080283.
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Since the discovery of antibiotics, the emergence of antibiotic resistance has become a global issue that is threatening society. In the era of antibiotic resistance, finding the proper antibiotics through antibiotic susceptibility testing (AST) is crucial in clinical settings. However, the current clinical process of AST based on the broth microdilution test has limitations on scalability to expand the number of antibiotics that are tested with various concentrations. Here, we used color-coded droplets to expand the multiplexing of AST regarding the kind and concentration of antibiotics. Color type and density differentiate the kind of antibiotics and concentration, respectively. Microscopic images of a large view field contain numbers of droplets with different testing conditions. Image processing analysis detects each droplet, decodes color codes, and measures the bacterial growth in the droplet. Testing E. coli ATCC 25922 with ampicillin, gentamicin, and tetracycline shows that the system can provide a robust and scalable platform for multiplexed AST. Furthermore, the system can be applied to various drug testing systems, which require several different testing conditions.
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Schmidt, Lena, Ailbhe N. Finnerty Mutlu, Rebecca Elmore, Babatunde K. Olorisade, James Thomas, and Julian P. T. Higgins. "Data extraction methods for systematic review (semi)automation: Update of a living systematic review." F1000Research 10 (October 9, 2023): 401. http://dx.doi.org/10.12688/f1000research.51117.2.
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Background: The reliable and usable (semi)automation of data extraction can support the field of systematic review by reducing the workload required to gather information about the conduct and results of the included studies. This living systematic review examines published approaches for data extraction from reports of clinical studies. Methods: We systematically and continually search PubMed, ACL Anthology, arXiv, OpenAlex via EPPI-Reviewer, and the dblp computer science bibliography. Full text screening and data extraction are conducted within an open-source living systematic review application created for the purpose of this review. This living review update includes publications up to December 2022 and OpenAlex content up to March 2023. Results: 76 publications are included in this review. Of these, 64 (84%) of the publications addressed extraction of data from abstracts, while 19 (25%) used full texts. A total of 71 (93%) publications developed classifiers for randomised controlled trials. Over 30 entities were extracted, with PICOs (population, intervention, comparator, outcome) being the most frequently extracted. Data are available from 25 (33%), and code from 30 (39%) publications. Six (8%) implemented publicly available tools Conclusions: This living systematic review presents an overview of (semi)automated data-extraction literature of interest to different types of literature review. We identified a broad evidence base of publications describing data extraction for interventional reviews and a small number of publications extracting epidemiological or diagnostic accuracy data. Between review updates, trends for sharing data and code increased strongly: in the base-review, data and code were available for 13 and 19% respectively, these numbers increased to 78 and 87% within the 23 new publications. Compared with the base-review, we observed another research trend, away from straightforward data extraction and towards additionally extracting relations between entities or automatic text summarisation. With this living review we aim to review the literature continually.
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Ceylan, Ahmet Cevdet, Haktan Bağış Erdem, İbrahim Şahin, and Meenal Agarwal. "SMN1 gene copy number analysis for spinal muscular atrophy (SMA) in a Turkish cohort by CODE-SEQ technology, an integrated solution for detection of SMN1 and SMN2 copy numbers and the “2+0” genotype." Neurological Sciences 41, no. 9 (April 6, 2020): 2575–84. http://dx.doi.org/10.1007/s10072-020-04365-x.
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Pearson, Derek T., Brian McArdle, Stefan J. Poslad, and Alan Murray. "A clinical evaluation of the performance characteristics of one membrane and five bubble oxygenators: haemocompatibility studies." Perfusion 1, no. 2 (July 1986): 81–98. http://dx.doi.org/10.1177/026765918600100203.
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The haemocompatibility of five different bubble oxygenators (Polystan venotherm, Harvey H-1700, Bentley BIO-10, Gambro 10 and Shiley S-100A HED) and one membrane oxygenator (Cobe CML) have been evaluated during standardized clinical perfusion for open-heart surgery in 48 adult patients. Control of arterial PO2 and PCO2 was an important feature of the evaluation protocol. Over the period of cardiopulmonary bypass (CPB) there was a marked difference in the mean percentage reduction in platelet count in the different oxygenator groups. Only 1% reduction in platelet count occurred with the Cobe CML membrane oxygenator group compared with, in the bubble oxygenator groups, 7% for the Gambro 10, 16% for the Harvey H-1700, 19% for the Shiley S-100A HED, 24% for the Bentley BIO-10 and 31% for the Polystan venotherm. The post bypass platelet count was significantly lower than the prebypass value in all oxygenator groups ( p < 0.05) except the Cobe CML and Gambro 10. The two oxygenator groups with the largest percentage reduction in platelet count (Polystan venotherm and Bentley BIO-1 0) demonstrated a significant reduction ( p < 0.05) in platelet aggregation over the period of bypass. Platelet depletion in the Harvey H-1700. Shiley S-100A HED, Bentley BIO-10 and Polystan venotherm oxygenators was associated with a significant fall ( p < 0.05) in mean platelet volume during the first 35 minutes of CPB due to the removal from the circulation of large, young, functionally more active platelets. Erythrocyte damage was minimal in all oxygenator groups and only a minor degree of leucopenia could be demonstrated during the first five minutes of CPB. Cardiotomy suction was not associated with significant changes in platelet numbers or platelet aggregation. When selecting the oxygenator for use in patients undergoing open-heart surgery, gas transfer characteristics and GME production together with the superior preservation of platelet numbers and function in the membrane oxygenator group and variable degree of platelet depletion and reduction in platelet aggregability demonstrated in the five bubble oxygenator groups, must be taken into account.
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Anfinogenova, Nina D., Oksana M. Novikova, Irina A. Trubacheva, Elena V. Efimova, Nazary P. Chesalov, Wladimir Y. Ussov, Aleksandra S. Maksimova, et al. "Prescribed Versus Taken Polypharmacy and Drug–Drug Interactions in Older Cardiovascular Patients during the COVID-19 Pandemic: Observational Cross-Sectional Analytical Study." Journal of Clinical Medicine 12, no. 15 (August 1, 2023): 5061. http://dx.doi.org/10.3390/jcm12155061.
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The study aimed to assess clinical pharmacology patterns of prescribed and taken medications in older cardiovascular patients using electronic health records (EHRs) (n = 704) (2019–2022). Medscape Drug Interaction Checker was used to identify pairwise drug–drug interactions (DDIs). Prevalence rates of DDIs were 73.5% and 68.5% among taken and prescribed drugs, respectively. However, the total number of DDIs was significantly higher among the prescribed medications (p < 0.05). Serious DDIs comprised 16% and 7% of all DDIs among the prescribed and taken medications, respectively (p < 0.05). Median numbers of DDIs between the prescribed vs. taken medications were Me = 2, IQR 0–7 vs. Me = 3, IQR 0–7 per record, respectively. Prevalence of polypharmacy was significantly higher among the prescribed medications compared with that among the taken drugs (p < 0.05). Women were taking significantly more drugs and had higher prevalence of polypharmacy and DDIs (p < 0.05). No sex-related differences were observed in the list of prescribed medications. ICD code U07.1 (COVID-19, virus identified) was associated with the highest median DDI number per record. Further research is warranted to improve EHR structure, implement patient engagement in reporting adverse drug reactions, and provide genetic profiling of patients to avoid potentially serious DDIs.
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Leahy, Aoife, Jason Hynes, Christine E. McCarthy, Amrita Roy, Nur Atikah Mohd Asri, Kiran Saif, Elizabeth Murphy, et al. "320 Assessment of Medication Prescribing using Test your Care Metrics." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.206.
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Abstract Background Medication records are essential components of patient care and a source of medical error. The HSE Code of Practice for Healthcare Records Management has highlighted criteria which must be complied with in these records. In the HSE Clinical Strategy and Programmes Division, “Test your care” is used to promote a code of practice and a set of metrics which need to be adhered to. Methods We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. We assessed the drug kardexes based on 9 different metrics. (Generic names used, capital letters used, start date recorded, legible dosing, route and frequency of medication documented, minimum dosing documented, legible prescriptions and discontinued drugs crossed off) Results 285 drug kardexes were reviewed. No drug kardex was fully compliant with the 9 standards. The main deficits were in relation to use of brand names, no documentation of frequency and omission of IMC numbers. The average number of metrics met was lower on surgical wards than medical wards - 3.6 vs 4.7 respectively, and this difference was statistically significant (p< .00001; 2 sample t test). Conclusion The universal poor compliance with these standards highlights both the poor design of the current drug kardex and poor awareness with prescribers of these standards. In the current drug kardex, there is no dedicated space for frequency or IMC number and therefore these are often forgotten. The use of brand names consistently highlights poor prescribing practice and more education is required to improve this. We plan to improve current prescribing education sessions for all doctors to highlight the current deficiencies and to increase compliance with standards.
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Eslami, Gilda, Samira Hatefi, Vahid Ramezani, Masoud Tohidfar, Tatyana V. Churkina, Yuriy L. Orlov, Saeedeh Sadat Hosseini, Mohammad Javad Boozhmehrani, and Mahmood Vakili. "Molecular characteristic of treatment failure clinical isolates of Leishmania major." PeerJ 9 (March 11, 2021): e10969. http://dx.doi.org/10.7717/peerj.10969.
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Background Leishmaniasis is a prevalent tropical disease caused by more than 20 Leishmania species (Protozoa, Kinetoplastida and Trypanosomatidae). Among different clinical forms of the disease, cutaneous leishmaniasis is the most common form, with an annual 0.6–1 million new cases reported worldwide. This disease’s standard treatment is pentavalent antimonial (SbV) that have been used successfully since the first half of the 20th century as a first-line drug. However, treatment failure is an increasing problem that is persistently reported from endemic areas. It is important to define and standardize tests for drug resistance in cutaneous leishmaniasis. SbV must be reduced to its trivalent active form (SbIII). This reduction occurs within the host macrophage, and the resultant SbIIIenters amastigotes via the aquaglyceroporin1 (AQP1) membrane carrier. Overexpression of AQP1 results in hypersensitivity of the parasites to SbIII, but resistant phenotypes accompany reduced expression, inactivation mutations, or deletion of AQP1. Hence, in this study, a phylogenetic analysis using barcode gene COXII and kDNA minicircle and expression analysis of AQP1 were performed in treatment failure isolates to assess the isolates’ molecular characteristics and to verify possible association with drug response. Methods Samples in this study were collected from patients with cutaneous leishmaniasis referred to the Diagnosis Laboratory Center in Isfahan Province, Iran, from October 2017 to December 2019. Among them, five isolates (code numbers 1–5) were categorized as treatment failures. The PCR amplification of barcode gene COXII and kDNA minicircle were done and subsequently analyzed using MEGA (10.0.5) to perform phylogenetics analysis of Treatment failures (TF) and Treatment response (TR) samples. Relative quantification of the AQP1 gene expression of TF and TR samples was assessed by real-time PCR. Results All samples were classified as L. major. No amplification failure was observed in the cases of barcode gene COXII and kDNA minicircle amplification. Having excluded the sequences with complete homology using maximum parsimony with the Bootstrap 500 method, four major groups were detected to perform phylogenetic analysis using COXII. The phylogenetic analysis using the barcode target of minicircle showed that all five treatment failure isolates were grouped in a separate sub-clade. Conclusions We concluded that the barcode gene COXII and the minicircle kDNA were suitable for identification, differentiation and phylogenetic analysis in treatment failure clinical isolates of Leishmania major. Also, AQP1 gene expression analyses showed that treatment failure isolates had less expression than TR isolates. The isolate with TF and overexpression of the AQP1 gene of other molecular mechanisms such as overexpression of ATP-binding cassette may be involved in the TR, such as overexpression of ATP-binding cassette which requires further research.
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Shi, Jiguang, Fei Wang, Moran Qin, Aiyun Chen, Wenhan Liu, Jin He, Hao Wang, Sheng Chang, and Qijun Huang. "New ECG Compression Method for Portable ECG Monitoring System Merged with Binary Convolutional Auto-Encoder and Residual Error Compensation." Biosensors 12, no. 7 (July 14, 2022): 524. http://dx.doi.org/10.3390/bios12070524.
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In the past few years, deep learning-based electrocardiogram (ECG) compression methods have achieved high-ratio compression by reducing hidden nodes. However, this reduction can result in severe information loss, which will lead to poor quality of the reconstructed signal. To overcome this problem, a novel quality-guaranteed ECG compression method based on a binary convolutional auto-encoder (BCAE) equipped with residual error compensation (REC) was proposed. In traditional compression methods, ECG signals are compressed into floating-point numbers. BCAE directly compresses the ECG signal into binary codes rather than floating-point numbers, whereas binary codes take up fewer bits than floating-point numbers. Compared with the traditional floating-point number compression method, the hidden nodes of the BCAE network can be artificially increased without reducing the compression ratio, and as many hidden nodes as possible can ensure the quality of the reconstructed signal. Furthermore, a novel optimization method named REC was developed. It was used to compensate for the residual between the ECG signal output by BCAE and the original signal. Complemented with the residual error, the restoration of the compression signal was improved, so the reconstructed signal was closer to the original signal. Control experiments were conducted to verify the effectiveness of this novel method. Validated by the MIT-BIH database, the compression ratio was 117.33 and the root mean square difference (PRD) was 7.76%. Furthermore, a portable compression device was designed based on the proposed algorithm using Raspberry Pi. It indicated that this method has attractive prospects in telemedicine and portable ECG monitoring systems.
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Pearson, D. T., and B. McArdle. "Haemocompatibility of membrane and bubble oxygenators." Perfusion 4, no. 1 (January 1989): 9–24. http://dx.doi.org/10.1177/026765918900400103.
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During clinical hypothermic cardiopulmonary bypass (CPB), the haemocompatibility of six groups of membrane oxygenators (Cobe CML2, Shiley M2000, Maxima, Bard HF4000, Bard HF5000, Capiox E has been studied in 60 patients having open-heart surgery. A standardized anaesthetic and perfusion protocol was used, during which the abilityof the perfusionist to achieve target blood gas values (PaO2 20kPa and PaCO2 5.3kPa: alpha-stat) using inline electrodes was assessed. Haemocompatibility was evaluated by measurement of platelet numbers and function, betathromboglobulin (BTG), plasma haemoglobin, complement (C3a des Arg) and white blood cell (WBC) count pre- and post-CPB. Platelet and WBC numbers were also measured every five minutes throughout CPB. All oxygenators allowed the perfusionist to control blood gases adequately to prescribed levels. There were only minor differences in the degree and pattern of platelet depletion, reduction in platelet aggregation, elevation of BTG and C3a des Arg observed between oxygenator groups, which did not appear to be influenced by membrane type (flat plate versus hollow fibre). The membrane oxygenator haematological data was amalgamated with that obtained in previous clinical studies using membrane and bubble oxygenators (Cobe CML, Polystan Venotherm, Harvey H 1700, Bentley BIO-10, Bentley 1 0B, Bentley 1 OPlus, Gambro 10 and Shiley S100A HED) in which a similar evaluation protocol was employed. Comparison of the percentage change in platelet count when the pre- and post-CPB values were compared, demonstrated statistically significantly less platelet depletion (p <0.001 ) in the membrane oxygenator groups (-0.2 ± 8.3%) when compared to the bubble oxygenator groups (-21.7 ± 8.7%). A significantly lower percentage rise in BTG was also observed in the membrane oxygenator group when compared to the bubble oxygenator groups (p <0.001 ). All oxygenator groups showed elevation of both WBC count and plasma haemoglobin with a nonspecific fall in platelet aggregation over the period of bypass but no significant differences could be found between the two types of oxygenator. Membrane oxygenators, when compared to bubble oxygenators, exhibit lower GME production and improved haemocompatibility and allow superior blood gas control. Membrane oxygenators manifestly must be the oxygenator type of choice for clinical CPB.
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Jerjes, Waseem, Daniele Ramsay, Harvey Stevenson, and Karima Lalji. "Mental Health Polypharmacy in “Non-Coded” Primary Care Patients: The Effect of Deprescribing." Journal of Clinical Medicine 13, no. 4 (February 7, 2024): 958. http://dx.doi.org/10.3390/jcm13040958.
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Background: Mental health (MH) polypharmacy, defined as prescribing multiple mental health medications for the same condition, presents significant challenges in clinical practice. With varying prevalence rates and an increasing trend, particularly in the UK, this deprescribing prospective quality improvement project aimed to address the complexities and risks associated with MH polypharmacy. Patients and Methods: A large primary care centre in London was selected for this project. Electronic records of 667 patients (non-coded in mental health lists) were analysed as a result of the absence of a Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) for mental health. Seventy-two non-coded patients exhibiting “same-class” as well as “adjunctive” and “augmentation” polypharmacy were identified. Their demographic and health data, including MH diagnoses, physical status, and lifestyle habits, were evaluated. This deprescribing prospective project included 68 patients and employed a model inspired by the Plan–Do–Study–Act (PDSA) cycle, focusing on reducing psychotropic, adjunctive, and augmentative medications while monitoring mental health control through face-to-face consultations using the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment-7 (GAD-7) scores, alongside physical health parameters. Results: The project revealed a significant decrease in the average number of psychotropic and adjunct medications from initial consultations to the end of the 18-month period. Additionally, a marked reduction in reported side effects and drug interactions was observed. Improvements in mental health control, as evidenced by PHQ-9 and GAD-7 scores, were noted. Physical health parameters, including BMI, blood pressure, heart rate, HbA1c, and cholesterol levels, also showed significant improvements. Educational initiatives for patients and clinicians were successfully implemented, contributing to these positive outcomes. Discussion: The project faced challenges like balancing medication reduction with mental health stability, patient apprehension, and the absence of standardised protocols. However, the successful reduction in medication numbers and the improvement in health outcomes highlight the effectiveness of the model. This project underscores the necessity of a tailored approach to MH polypharmacy, emphasising continuous education, clinical titration, and adherence to guidelines. Future research is needed to develop clear guidelines for medication combination in mental health care and to understand the long-term effects of polypharmacy in mental health populations. Conclusions: This project demonstrates the potential for significant improvements in the management of MH polypharmacy. By carefully managing medication reductions and employing a comprehensive care approach, including patient education and clinician training, the project achieved improvements in both mental and physical health outcomes. These findings suggest a promising direction for future practices in MH polypharmacy management.
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Karanth, NisargS, SathishRaju Nilakantam, Dayananda Melanahalli, SB Adarsh, and NPradeep Kumar. "Prehospital emergency care model using short code access number for refining dispatching of ambulances and clinical communication for patient transfer–Insights from a Private Medical College and Hospital, Mysuru, India." International Journal of Health & Allied Sciences 10, no. 4 (2021): 257. http://dx.doi.org/10.4103/ijhas.ijhas_180_20.
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Alam, Khairul, Hasib Sheikh, and Md Abdus Samad. "Clinical Effect of Poly Herbal Unani Formulation on Dyslipidemia- A Randomized Trial." Turkish Journal of Agriculture - Food Science and Technology 11, no. 10 (October 24, 2023): 1892–904. http://dx.doi.org/10.24925/turjaf.v11i10.1892-1904.6185.
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Background: In adults aged 30-70 with primary and moderate hyperlipidemia, the present study took place to investigate the therapeutic benefits of a polyherbal unani preparation called Garlitab. Methods: It was a prospective open label, herbal coded test drug-controlled, randomized trial. Out of total screened patients we were enrolled 212 hyperlipidemic patients of 30–70 years in the study fulfilling the inclusion criteria, we were recruited them from OPD of a hospital in Munshiganj and different Unani clinics of Dhaka, Bangladesh after obtaining written informed consent from the patients. Selected individuals were allocated into two groups at random. Group1 Received 500 mg Garlitab tablets twice daily and Group 2 received tablet atorvastatin calcium 10 mg 2 times daily. Height, weight, and blood pressure were recorded along with blood samples. The random distributions were carried out by a research assistant utilizing a random numbers table. Blood samples were taken at the beginning of the trial, 1.5 months later, and 3 months following the intervention. Results: Results for the test medication revealed a substantial drop in cholesterol levels between baseline and the data collected after three months and in case of male it was from 241.72±38.11 to 218.24±34.06 mg/dL for total cholesterol, from 198.27±30.57 to 173.54±29.34 mg/dL for LDL and from 280.78±85.81 to 207.07±51.40 mg/dL for triglyceride. HDL increases from 33.05±3.21 to 34.69±3.13 mg/dL in male patients. The control drug atorvastatin calcium also showed a significant decrease in lipids between baseline and after 3 months data and in case of male it was from 241.92±31.54 to 174.90±22.87 mg/dL for total cholesterol, from 196.20±30.91 to 130.30±24.29 mg/dL for LDL and from 279.48±115.35 to 141.27±59.55 mg/dL for triglyceride. It increases HDL from 32.00±2.25 to 34.03±2.19 mg/dL in male patients. Between the baseline and the 3-month data, the test medicine for females significantly reduced total cholesterol, LDL, and triglycerides and it was from 244.64±52.18 to 220.12±45.07 mg/dL, from 200.32±30.57 to 173.54±29.34 mg/dL and from 272.32±99.69 to 195.25±60.68 mg/dL respectively. HDL increases from 33.77±3.36 to 35.03±3.23 mg/dL. Between the baseline and the 3-month data, the control medication for females significantly reduced total cholesterol, LDL, and triglycerides and it was from 247.74±37.95 to 175.26±29.54 mg/dL, from 197.65±27.89 to 130.91±22.04 mg/dL and from 271.57±94.52 to 142.00±50.88 mg/dL respectively. It increases HDL from 32.22±2.32 to 33.46±2.94 mg/dL. Conclusions: According to the results of the study, the polyherbal formulation Garlitab can lower cholesterol levels. It may be a useful medication for treating primary hyperlipidemia.
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Demirkaya, Alper, Mehmet han, and zeynep al. "PROGNOSTIC VALUE OF NEUTROPHIL / LYMPHOCYTE, PLATELET / LYMPHOCYTE, AND MPV IN PATIENTS DIAGNOSED WITH PULMONARY EMBOLI." Annals of Medical Research 29, no. 9 (2022): 1. http://dx.doi.org/10.5455/annalsmedres.2022.04.146.
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Aim: Pulmonary Embolism (PE) is an obstructive disease of the pulmonary arterial system of varying degrees and localization and usually stems from the embolization of the thrombus or non-thrombotic substances originating from the deep veins of the lower extremities. Pulmonary embolism is a preventable disease that has a high probability of recurrence, high mortality, and morbidity. The differential diagnosis and clinical treatment of pulmonary embolism have a very important place in emergency service applications. The purpose of the present study was to retrospectively examine the patients who applied to Inonu University Turgut Ozal Medical Center Emergency Service between 2014 and 2019 and were diagnosed with PE. Materials and Methods: In the present study, the data were collected retrospectively from a total of 144 patients including 80 female and 64 male patients who applied to Turgut Ozal Medical Center (TOTM) Emergency Department with the complaints of sweating, chest pain, cough, hemoptysis, and syncope between January 2014 and August 2019 and diagnosed with PE with the I-26 diagnostic code according to the ICD 10 coding system. The quantitative data obtained from the patients were summarized as mean and standard deviation or median, as well as minimum and maximum, and the qualitative data were summarized as numbers and percentages. The compatibility of the data with the normal distribution was evaluated with the Kolmogorov Smirnov test and the homogeneity of the variances was examined with the Levene test. The Independent Samples t-test and Mann Whitney U test were used to analyze the data. The IBM SPSS Statistics version 26.0 for Windows package program was used in the analyses. A P<0.05 value was taken as statistically significant. Results: No significant differences were detected in terms of systolic arterial blood pressure, diastolic arterial blood pressure, and laboratory variables of leukocyte, lymphocyte, neutrophil, neutrophil/lymphocyte, and platelet/lymphocyte ratios between the PE patients with and without right ventricular dilatation on ECHO. Statistically significant differences were detected for platelet, MPV, and CRP between the patients with and without right ventricular dilatation in ECHO. Conclusion: It is considered that these findings will provide data on the prognosis and general condition of patients and will help the clinician to make an earlier and easier prediction about the clinical prognosis of patients.
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Rasmussen, H. B., and J. Clausen. "Large Number of Polymorphic Nucleotides and a Termination Codon in theenvGene of the Endogenous Human Retrovirus ERV3." Disease Markers 14, no. 3 (1998): 127–33. http://dx.doi.org/10.1155/1998/958379.
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The terminal portion of thepolgene and the entireenvgene of the human endogenous retrovirus ERV3 was screened for polymorphic nucleotides. For this purpose fragments amplified from the desired regions of ERV3 were subjected to single strand conformational analysis (SSCP analysis). Using this approach, we detected 13 polymorphic nucleotides, namely four in thepolgene and nine in theenvgene. Three of the nucleotide substitutions were synonymous (not affecting the amino acid code). One of the non-synonymous nucleotide substitutions changed an arginine codon to a termination codon. The alleles at the different polymorphic sites could be arranged into five ERV3 haplotypes, two of which were new.To evaluate the possible significance of the termination codon, which precludes expression of a putative immunoregulatory factor, we examined samples of DNA from patients with multiple sclerosis, a demyelinating disease of presumed autoimmune etiology. We did not find an association between the ERV3 allele with the termination codon and this disease.Perhaps the presence of a stop codon combined with the high number of non-synonymous nucleotide substitutions in the reading frame of theenvgene reflects absence of selective constraints during evolution. Obviously, our findings contradict the assumption that the reading frame of the ERV3envgene has been conserved throughout evolution.
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Coma Redon, Ermengol, Nuria Mora, Albert Prats-Uribe, Francesc Fina Avilés, Daniel Prieto-Alhambra, and Manuel Medina. "Excess cases of influenza and the coronavirus epidemic in Catalonia: a time-series analysis of primary-care electronic medical records covering over 6 million people." BMJ Open 10, no. 7 (July 2020): e039369. http://dx.doi.org/10.1136/bmjopen-2020-039369.
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ObjectivesThere is uncertainty about when the first cases of COVID-19 appeared in Spain. We aimed to determine whether influenza diagnoses masked early COVID-19 cases and estimate numbers of undetected COVID-19 cases.DesignTime-series study of influenza and COVID-19 cases, 2010–2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople registered in primary-care practices, covering >6 million people and >85% of the population.Main outcome measuresWeekly new cases of influenza and COVID-19 clinically diagnosed in primary care.AnalysesDaily counts of both cases were computed using the total cases recorded over the previous 7 days to avoid weekly effects. Epidemic curves were characterised for the 2010–2011 to 2019–2020 influenza seasons. Influenza seasons with a similar epidemic curve and peak case number as the 2019–2020 season were used to model expected case numbers with Auto Regressive Integrated Moving Average models, overall and stratified by age. Daily excess influenza cases were defined as the number of observed minus expected cases.ResultsFour influenza season curves (2011–2012, 2012–2013, 2013–2014 and 2016–2017) were used to estimate the number of expected cases of influenza in 2019–2020. Between 4 February 2020 and 20 March 2020, 8017 (95% CI: 1841 to 14 718) excess influenza cases were identified. This excess was highest in the 15–64 age group.ConclusionsCOVID-19 cases may have been present in the Catalan population when the first imported case was reported on 25 February 2020. COVID-19 carriers may have been misclassified as influenza diagnoses in primary care, boosting community transmission before public health measures were taken. The use of clinical codes could misrepresent the true occurrence of the disease. Serological or PCR testing should be used to confirm these findings. In future, this surveillance of excess influenza could help detect new outbreaks of COVID-19 or other influenza-like pathogens, to initiate early public health responses.
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Triep, Karen, Nenad Torbica, Luigi Raio, Daniel Surbek, and Olga Endrich. "The Robson classification for caesarean section—A proposed method based on routinely collected health data." PLOS ONE 15, no. 11 (November 30, 2020): e0242736. http://dx.doi.org/10.1371/journal.pone.0242736.
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Background With an increasing rate of caesarean sections as well as rising numbers of multiple pregnancies, valid classifications for benchmarking are needed. The Robson classification provides a method to group cases with caesarean section in order to assess differences in outcome across regions and sites. In this study we set up a novel method of classification by using routinely collected health data. We hypothesize i that routinely collected health data can be used to apply complex medical classifications and ii that the Robson classification is capable of classifying mothers and their corresponding newborn into meaningful groups with regard to outcome. Methods and findings The study was conducted at the coding department and the department of obstetrics and gynecology Inselspital, University Hospital of Bern, Switzerland. The study population contained inpatient cases from 2014 until 2017. Administrative and health data were extracted from the Data Warehouse. Cases were classified by a Structured Query Language code according to the Robson criteria using data from the administrative system, the electronic health record and from the laboratory system. An automated query to classify the cases according to Robson could be implemented and successfully validated. A linkage of the mother’s class to the corresponding newborn could be established. The distribution of clinical indicators was described. It could be shown that the Robson classes are associated to outcome parameters and case related costs. Conclusions With this study it could be demonstrated, that a complex query on routinely collected health data would serve for medical classification and monitoring of quality and outcome. Risk-stratification might be conducted using this data set and should be the next step in order to evaluate the Robson criteria and outcome. This study will enhance the discussion to adopt an automated classification on routinely collected health data for quality assurance purposes.
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Sheikh, Hasib, Md Khairul Alam, and Md Abdus Samad. "Comprehensive Evaluation of the Clinical Efficacy of an Anti-Diabetic Polyherbal Formulation." Turkish Journal of Agriculture - Food Science and Technology 11, no. 10 (October 24, 2023): 1905–16. http://dx.doi.org/10.24925/turjaf.v11i10.1905-1916.6212.
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Background: There are several clinical studies examining the health advantages of several single medicinal herbs utilized in traditional blood glucose-lowering treatments. But very few or no studies on herbal formulations were made as Polyherbal for the same goal. As a result, it is now necessary to confirm that patients with hyperglycemia can benefit from such Polyherbal medicines as Dolabi. Methods: This prospective open-label, herbal coded test drug-controlled, randomized trial was conducted at the Munshiganj and Dhaka area in Bangladesh. We enrolled 108 male and 104 female patients of 30-70 years with primary and moderate hyperglycemia. They were recruited from the OPD of an Unani & Ayurvedic hospital in Munshiganj and different Unani clinics in Dhaka, Bangladesh after fulfilling the inclusion criteria. Patients were randomly assigned to receive metformin hydrochloride 500 mg two times daily and 2 tablets of Dolabi two times daily by using a random numbers table with the help of an assistant. Blood samples, height, weight, blood pressure, and personal data were recorded—laboratory results were obtained at the study baseline, after 1.5 months and after 3 months of intervention. Results: In the case of the test drug, results showed a significant decrease in blood glucose level between the baseline and after 3 months, in males, it was from 9.83±1.17 to 7.72±1.06 mg/dL for fasting glucose, from 16.60±2.35 to 8.23±1.17 mg/dL for 2 hours PP glucose, from 9.33±1.17 to 7.45±2.03 percent for HbA1c and for Insulin it reduces from 183.10±27.59 to 168.10±29.59 pmol/ L. The control drug metformin hydrochloride also showed a significant decrease in blood glucose level between baseline and after 3 months, in the case of males it was from 9.99±2.52 to 6.97±1.76 mg/dL for fasting glucose, from 17.43±5.05 to 7.89±2.42 mg/dL for 2 hours PP glucose, from 10.43±2.36 to 6.87±1.18 percent for HbA1c and for Insulin it reduces from 198.75±30.61 to 183.75±30.61p mol/L. In the case of females the test drug showed a significant reduction in fasting glucose, 2 hours PP glucose, HbA1c and Insulin between the baseline and after 3 months, it was from 10.02±1.11 to 7.78±0.93 mg/dL, from 16.88±2.21 to 8.16±1.11 mg/dL, from 9.84±1.04 to 7.45±1.03 percent and from 199.47±30.90 to 173.47±30.90 mg/dL respectively. In the case of females, the control drug showed a significant reduction in fasting glucose, 2 hours PP glucose, HbA1c and Insulin between baseline and after 3 months, it was from 10.18±1.92 to 6.71±1.59 mg/dL, from 18.70±3.88 to 7.60±3.74 mg/dL, from 10.58±1.08 to 6.98±1.08 percent and from 200.00±31.83 to 188.00±31.83 mg/dL respectively. Conclusions: We can infer the following from the present study’s findings: The polyherbal formulation Dolabi is able to reduce the blood glucose level. It can be an effective drug for primary hyperglycemic patients.
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Qureshi, Sheeraz A., Steven McAnany, Vadim Goz, Steven M. Koehler, and Andrew C. Hecht. "Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion." Journal of Neurosurgery: Spine 19, no. 5 (November 2013): 546–54. http://dx.doi.org/10.3171/2013.8.spine12623.
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Object In recent years, there has been increased interest in the use of cervical disc replacement (CDR) as an alternative to anterior cervical discectomy and fusion (ACDF). While ACDF is a proven intervention for patients with myelopathy or radiculopathy, it does have inherent limitations. Cervical disc replacement was designed to preserve motion, avoid the limitations of fusion, and theoretically allow for a quicker return to activity. A number of recently published systematic reviews and randomized controlled trials have demonstrated positive clinical results for CDR, but no studies have revealed which of the 2 treatment strategies is more cost-effective. The purpose of this study was to evaluate the cost-effectiveness of CDR and ACDF by using the power of decision analysis. Additionally, the authors aimed to identify the most critical factors affecting procedural cost and effectiveness and to define thresholds for durability and function to focus and guide future research. Methods The authors created a surgical decision model for the treatment of single-level cervical disc disease with associated radiculopathy. The literature was reviewed to identify possible outcomes and their likelihood following CDR and ACDF. Health state utility factors were determined from the literature and assigned to each possible outcome, and procedural effectiveness was expressed in units of quality-adjusted life years (QALYs). Using ICD-9 procedure codes and data from the Nationwide Inpatient Sample, the authors calculated the median cost of hospitalization by multiplying hospital charges by the hospital-specific cost-to-charge ratio. Gross physician costs were determined from the mean Medicare reimbursement for each current procedural terminology (CPT) code. Uncertainty as regards both cost and effectiveness numbers was assessed using sensitivity analysis. Results In the reference case, the model assumed a 20-year duration for the CDR prosthesis. Cervical disc replacement led to higher average QALYs gained at a lower cost to society if both strategies survived for 20 years ($3042/QALY for CDR vs $8760/QALY for ACDF). Sensitivity analysis revealed that CDR needed to survive at least 9.75 years to be considered a more cost-effective strategy than ACDF. Cervical disc replacement becomes an acceptable societal strategy as the prosthesis survival time approaches 11 years and the $50,000/QALY gained willingness-to-pay threshold is crossed. Sensitivity analysis also indicated that CDR must provide a utility state of at least 0.796 to be cost-effective. Conclusions Both CDR and ACDF were shown to be cost-effective procedures in the reference case. Results of the sensitivity analysis indicated that CDR must remain functional for at least 14 years to establish greater cost-effectiveness than ACDF. Since the current literature has yet to demonstrate with certainty the actual durability and long-term functionality of CDR, future long-term studies are required to validate the present analysis.
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Eby, D., and J. Woods. "P052: The importance of structured ambulance radio patches during termination of resuscitation calls." CJEM 19, S1 (May 2017): S95. http://dx.doi.org/10.1017/cem.2017.254.
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Introduction: Pre-hospital telecommunication (patches) requires a special type of conversation. Receiving and processing correct information is critical when making clinical decisions, such as a termination of resuscitation (ToR). In a study of radio patches, a common patch structure emerged from the data analysis. Use of this standard structure resulted in shorter and less confusing patches. We sought to understand patch structure to be able to target interventions to improve the quality and efficiency of communication needed for critical clinical decisions. Methods: We undertook a retrospective analysis of all ToR patches between physicians and paramedics from 4 paramedic services, recorded by the Ambulance Dispatch Centre between Jan 01-Dec 31, 2014. Four services used Primary Care Paramedics and 1 service also used Advanced Care Paramedics. MP3 patch recording files were anonymized, transcribed, and read multiple times by the authors. Transcripts were coded and analyzed using mixed methods-quantitative descriptive statistics and qualitative thematic framework analysis. Results: The data set was 127 ToR patches-466 pages of transcripts. 116 patches (91.3%) had a standard structure (SS): participant introduction, clinical data presentation, clarification of data, making the decision, exchange of administrative information, and sign off. Paramedics used a mean of 81 words (95CI 74,88) to present the ‘clinical data’. Enough data was presented to meet ToR rule criteria in 52 cases (44.8%). Before making a decision to terminate resuscitation, physicians sought clarification in 100 cases (78.7%). After making the ToR decision, some physicians needed to justify their decision by seeking more data in 17 cases (13.4%). Exchange of non-clinical information (numbers, times, name spellings) took a mean of 200 words (95CI 172,228) and averaged 84 seconds or 35% of the average patch time. SS patches used a mean of 558 words, and lasted 234 sec (95CI 215,252). Non-SS patches used a mean of 654 words and lasted 286 sec (95CI 240,332). Conclusion: The most common patch structure consisted of participant introduction, data presentation, clarification of data, making the clinical decision, exchange of administrative information, and a sign off. Deviation from this SS resulted in longer patches. When a non-SS patch structure was used, the patching paramedic was tied up 25% longer and unavailable to provide patient care.
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Ziarko, Tomasz Piotr, Nike Walter, Melanie Schindler, Volker Alt, Markus Rupp, and Siegmund Lang. "Risk Factors for the In-Hospital Mortality in Pyogenic Vertebral Osteomyelitis: A Cross-Sectional Study on 9753 Patients." Journal of Clinical Medicine 12, no. 14 (July 21, 2023): 4805. http://dx.doi.org/10.3390/jcm12144805.
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Background: Pyogenic vertebral osteomyelitis represents a clinical challenge associated with significant morbidity and mortality. The aim of this study was to analyze potential risk factors for the in-hospital mortality of vertebral osteomyelitis (VO) patients. Methods: Based on the International Classification of Diseases, 10th Revision (ICD-10) codes for VO (“M46.2-”, “M46.3-”, and “M46.4-”) data for total case numbers, secondary diagnoses, and numbers of in-hospital deaths were extracted from the Institute for the Hospital Remuneration System (InEK GmbH). Odds ratios (OR) for death were calculated for several secondary diseases and factors of interest. Results: Despite age, certain comorbidities were found to be strongly associated with increased mortality risk: Heart failure (OR = 2.80; 95% CI 2.45 to 3.20; p < 0.01), chronic kidney disease (OR = 1.83; 95% CI 1.57 to 2.13; p < 0.01), and diabetes with complications (OR = 1.86; 95% CI 1.46 to 2.38; p < 0.01). Among the complications, acute liver failure showed the highest risk for in-hospital mortality (OR = 42.41; 95% CI 23.47 to 76.62; p < 0.01). Additionally, stage III kidney failure (OR = 9.81; 95% CI 7.96 to 12.08; p < 0.01), sepsis (OR = 5.94; 95% CI 5.02 to 7.03; p < 0.01), acute respiratory failure (OR = 5.31; 95% CI 4.61 to 6.12; p < 0.01), and systemic inflammatory response syndrome (SIRS) (OR = 5.19; 95% CI 3.69 to 5.19; p < 0.01) were associated with in-hospital mortality. When analyzing the influence of pathogens, documented infection with Pseudomonas aeruginosa had the highest risk for mortality (OR = 2.74; 95% CI 2.07 to 3.63; p < 0.01), followed by Streptococci, Escherichia coli, and Staphylococcus aureus infections. Conclusions: An early assessment of individual patient risk factors may be beneficial in the care and treatment of VO to help reduce the risks of mortality. These findings emphasize the importance of closely monitoring VO patients with chronic organ diseases, early detection and treatment of sepsis, and tailored empirical antibiotic therapy. The identification of specific pathogens and antibiotic susceptibility testing should be prioritized to improve patient outcomes in this high-risk population.
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Saliba, Jason, Arpad Danos, Kilannin Krysiak, Adam Coffman, Susanna Kiwala, Joshua McMichael, Cameron J. Grisdale, et al. "Abstract 6569: ClinGen Somatic and CIViC collaborate to comprehensively evaluate somatic variants in cancer." Cancer Research 83, no. 7_Supplement (April 4, 2023): 6569. http://dx.doi.org/10.1158/1538-7445.am2023-6569.
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Abstract The comprehensive evaluation of somatic variants in cancer requires consensus interpretation of their potential clinical significance (diagnosis, prognosis, and treatment response) and oncogenicity. To aid precision medicine through public interpretations, a multifaceted collaborative effort is required to bring together a community, structured guidance, and a public platform. The over 200 multi-disciplinary experts in the Clinical Genome Resource (ClinGen) Somatic Cancer Clinical Domain Working Group (CDWG) provide a community that develops data curation guidelines and standards and curates evidence to determine the clinical significance and oncogenicity of somatic alterations in cancer. The Somatic CDWG established the Pediatric Cancer, Hematological Cancer, and Solid Tumor Taskforces to facilitate membership growth and targeted curation projects. Within these Taskforces, Somatic Cancer Variant Curation Expert Panels (SC-VCEPs) are developed through a 4-step approval process adapted from ClinGen germline VCEP procedures. Five SC-VCEPs (NTRK-fusions, FGFR variants, FLT3 variants, Histone H3 variants, and BCR::ABL1-like B-ALL alterations) are working through the approval process and one (Established Significance) is in the planning stage. SC-VCEPs tailor AMP/ASCO/CAP [PMID:27993330] and ClinGen/CGC/VICC Oncogenicity [PMID:35101336] guidelines, or create new classification guidance to aid granular assessment of their genomic alterations of interest. The Clinical Interpretations of Variants in Cancer (CIViC) knowledgebase provides the public platform for the Taskforces and SC-VCEPs to display their high-quality somatic cancer variant interpretations. These groups curate evidence from published literature and create Assertions summarizing evidence collected. These Assertions are further disseminated through other resources like ClinVar and the Variant Interpretation for Cancer Consortium (VICC) MetaKB. CIViC supports the application of AMP/ASCO/CAP tiering and levels for clinical significance Assertions. CIViC recently created Oncogenic Assertions, which supports the application of ClinGen/CGC/VICC codes. Three SC-VCEPs (FGFR, FLT3, and Histone H3) are tailoring the ClinGen/CGC/VICC Oncogenicity guidelines to their specific genes and CIViC will enable their ClinGen-approved, modified codes to be applied directly to their Oncogenic Assertions. Also, two SC-VCEPs (NTRK and BCR::ABL1-like) are developing fusion specific oncogenicity classification guidelines, which will be applied to their fusion specific CIViC Oncogenic Assertions. ClinGen Somatic groups have generated 695 CIViC Evidence Items and 33 Assertions from over 400 published papers. These numbers will continue to grow along with the development of more SC-VCEPs. ClinGen Somatic and CIViC foster collaboration, innovation, and most importantly the advancement of precision medicine. Citation Format: Jason Saliba, Arpad Danos, Kilannin Krysiak, Adam Coffman, Susanna Kiwala, Joshua McMichael, Cameron J. Grisdale, Ian King, Shamini Selvarajah, Xinjie Xu, Rashmi Kanagal-Shamanna, Laveniya Satgunaseelan, David Meredith, Mark Evans, Charles G. Mullighan, Yassmine Akkari, Gordana Raca, Angshumoy Roy, Alex H. Wagner, Ramaswamy Govindan, Obi L. Griffith, Malachi Griffith, on behalf of the ClinGen Somatic Clinical Domain Working Group. ClinGen Somatic and CIViC collaborate to comprehensively evaluate somatic variants in cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6569.
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Stein, Laura K., Stanley Tuhrim, Nathalie Jette, Johanna Fifi, J. Mocco, and Mandip S. Dhamoon. "Nationwide Analysis of Endovascular Thrombectomy Provider Specialization for Acute Stroke." Stroke 51, no. 12 (December 2020): 3651–57. http://dx.doi.org/10.1161/strokeaha.120.029989.
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Background and Purpose: Determine the extent of cerebrovascular expertise among the specialties of proceduralists providing endovascular thrombectomy (ET) for emergent large vessel occlusion stroke in the modern era of acute stroke among Medicare beneficiaries Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision , Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ET. We identified proceduralist specialty by linking the National Provider Identifier provided by Medicare to the specialty listed in the National Provider Identifier database, grouping into radiology, neurology, neurosurgery, other surgical, and internal medicine. We calculated the number of proceduralists and hospitals who performed ET, ET team specialty composition by hospital, and number of proceduralists who performed ET at multiple hospitals. Results: Forty-two percent (n=5612) of ET were performed by radiology-background proceduralists, with unclear knowledge of how many were cerebrovascular specialists. Neurosurgery- and neurology-background interventionalists performed fewer but substantial numbers of cases, accounting for 24% (n=3217) and 23% (n=3124) of total cases, respectively. ET teams included a neurology- or neurosurgery-background proceduralist at 65% (n=407) of hospitals that performed ET and included both in 26% (n=160) of teams. Conclusions: Almost two-thirds of ET teams nationwide include a neurology- or neurosurgery-background proceduralist and higher volume centers in urban areas were more likely to have neurology- or neurosurgery-background proceduralists with cerebrovascular expertise on their team. It is unclear how many radiology-background interventionalists are cerebrovascular specialists versus generalists. Significant work remains to be done to understand the impact of proceduralist specialty, training, and cerebrovascular expertise on ET outcomes.
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Asombang, A. W., R. Madsen, M. Simuyandi, G. Phiri, M. Bechtold, J. A. Ibdah, K. Lishimp, and L. Banda. "Pancreatic cancer: Patterns in a low- to middle- income Ppopulation, Zambia." Medical Journal of Zambia 44, no. 4 (December 31, 2017): 212–17. http://dx.doi.org/10.55320/mjz.44.4.278.
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Introduction: In 2007, the Cancer Disease Hospital (CDH) was opened as the national referral center for patients diagnosed with cancer in Zambia. Since inception of the CDH, there has been no systematic analysis of the disease burden and implication on healthcare delivery with regards to pancreatic cancer. There are limited studies describing patterns of pancreatic cancer in a native African population. Data suggest African-Americans have a higher incidence and poorer prognosis of pancreatic cancer than non-African Americans.Objective: Our aim is to describe the demographic features (age, gender) of pancreatic cancer using the Cancer Disease Hospital (CDH) data base in a native African population and compare with the African-American cohort using the Surveillance, Epidemiology End Results (SEER) Program database.Methods: This was a retrospective study of patients diagnosed with pancreatic cancer at the CDH in Zambia, Southern Africa between 2007 and 2014. We entered the term “pancreatic cancer” into the CDH database, extracted patient medical records numbers, and manually located the records for review. From each chart we extracted: age, gender, geographic origin, ethnicity, clinical features at presentations, location of tumor, stage at diagnosis and treatment. Data collection tool and master code sheet created a priori were used. Data was analyzed using statistical analysis software (SAS). Descriptive statistics including means, medians as well as frequency distributions and crosstabulations were used. SEER database was used to compare subjects between Zambia and USA. Groups were compared using Chi-square tests and Wilcoxon Signed Rank test. Ap-value less than 0.05 was used as the level of significance.Results: Thirty-eight charts were identified in the CDH dataset, of which 27 were included in final analysis and 11 excluded (5 non-pancreatic cancer diagnosis, 6 not manually located). The mean age of diagnosis was 55.7 years in the native African population, compared to 66.7 years for the African-Americans in the SEER database, p < 0.0001. There were 63.0% males (CDH) compared to 48.1% (SEER), p=0.121. Further review of the CDH database revealed that the most common presenting symptom was abdominal pain (52.6%), mode of diagnosis surgical (83%, missing 3), histopathology adenocarcinoma (86%, missing 6), location head of pancreas (83%, missing 9) and stage 4 at diagnosis (100%, missing 3).Conclusion: Pancreatic cancer occurs at a younger age in Zambians when compared to the African American, USApopulation. There is no statistically significant difference in sex presentation between Zambian and USAblack population.
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Piatt, Joseph. "Principles of system design not realized for pediatric craniospinal trauma care in the United States." Journal of Neurosurgery: Pediatrics 22, no. 1 (July 2018): 9–17. http://dx.doi.org/10.3171/2018.1.peds17625.
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OBJECTIVEAn implicit expectation of the pioneers of trauma system design was that high clinical volume at select centers could lead to superior outcomes. There has been little study of the regionalization of pediatric craniospinal trauma care, and whether it continues to trend in the direction of regionalization is unknown. The motivating hypothesis for this study was that trauma system design in the United States is proceeding on a rational basis, producing hospital caseloads that are increasing over time and, because of geographic siting appropriate to the needs of catchment areas, in an increasingly uniform manner.METHODSData were obtained from the Kids’ Inpatient Database (KID) for 1997, 2000, 2003, 2006, 2009, and 2012. Cases of traumatic spinal injury (TSI) and severe traumatic brain injury (sTBI) were identified by ICD-9 diagnostic and procedural codes. Records of patients 18 years of age and older were excluded. Hospital caseloads and descriptive statistics were calculated for each year of the study, and trends were examined. The distributions of hospital caseloads were compared year with year and with simulations of idealized systems.RESULTSCaseloads of TSI trended upward and caseloads of sTBI were stable, despite a declining nationwide incidence of these conditions during the study period, so the pool of hospitals providing services for pediatric craniospinal trauma contracted to a degree. The distributions of hospital caseloads did not change, and in every year of the study large numbers of hospitals reported small numbers of discharges. In the last year of the study, a quarter of all children with TSI were discharged from hospitals that treated approximately 1 case or fewer every other month and a quarter of all children with sTBI were discharged from hospitals that treated 1 case or fewer every 3 months.CONCLUSIONSThere has been no previous study of nationwide trends in pediatric craniospinal trauma caseloads. Analysis of hospital caseloads from 1997 through 2012 supports inference of a persisting geographical mismatch between population needs and the availability of services. These observations falsify the study hypothesis. A notable fraction of pediatric craniospinal trauma care continues to be rendered at low-caseload institutions. Novel quality assurance methods tailored to the needs of low-caseload institutions deserve development and study.
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Si, Si, Richard Ofori-Asenso, Tom Briffa, Jenni Ilomaki, Frank Sanfilippo, Christopher M. Reid, and Danny Liew. "Dispensing Patterns of Blood Pressure Lowering Agents in Older Australians From 2006 to 2016." Journal of Cardiovascular Pharmacology and Therapeutics 24, no. 3 (November 21, 2018): 242–50. http://dx.doi.org/10.1177/1074248418812184.
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Background: Increasing numbers of blood pressure lowering (BPL) agents are being prescribed for both primary and secondary prevention of cardiovascular disease, especially in the older population. The aim of this study is to describe the temporal trends and patterns of BPL dispensing among older Australians (aged ≥65 years). Methods: We utilized prescription claims data from the Australian Pharmaceutical Benefits Scheme (PBS) for a 10% random sample of people aged ≥65 years. The PBS, funded by the Federal government, provides subsidies to make medicines more affordable for Australian residents. We restricted our analysis to “long-term concession” individuals, who would use PBS for the majority of their medication needs. BPL agents were identified using the World Health Organization Anatomical Therapeutic Chemical classification codes. The annual prevalences and proportional distributions of BPL dispensing by categories were summarized from 2006 to 2016. Direct standardization was applied to indicate changes of BPL dispensing over time. Results: Age-standardized dispensing of BPL agents increased by 8% among older Australians from 2006 to 2016 (58%-66%). BPL dispensing in males has exceeded that in females since 2009. Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were the dominant BPL agents dispensed, with more than 55% of all BPL users over time. Dispensing of diuretics decreased from 27% to 21%, calcium channel blockers decreased from 30% to 25%, while β-blockers remained stable (29%-31%). The use of fixed-dose combinations increased over time from 23% to 31%. Conclusion: The prevalence of BPL dispensing steadily increased among older Australians from 2006 to 2016. The changes in the patterns of BPL dispensing were largely in line with contemporary changes to clinical guidelines for an aging population.
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Asombang, Akwi W., R. Madsen, M. Simuyandi, G. Phiri, M. Bechtold, J. A. Ibdah, K. Lishimpi, and L. Banda. "Pancreatic Cancer: Patterns in a Low- to Middle-Income Population, Zambia." Medical Journal of Zambia 44, no. 4 (December 29, 2017): 212–17. http://dx.doi.org/10.55320/mjz.44.4.96.
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Introduction In 2007, the Cancer Disease Hospital (CDH) was opened as the national referral center for patients diagnosed with cancer in Zambia. Since inception of the CDH, there has been no systematic analysis of the disease burden and implication on healthcare delivery with regards to pancreatic cancer. There are limited studies describing patterns of pancreatic cancer in a native African population. Data suggest African-Americans have a higher incidence and poorer prognosis of pancreatic cancer than non-African Americans.
Objective:
Our aim is to describe the demographic features (age, gender) of pancreatic cancer using the Cancer Disease Hospital (CDH) data base in a native African population and compare with the African-American cohort using the Surveillance, Epidemiology End Results (SEER) Program database.
Methods This was a retrospective study of patients diagnosed with pancreatic cancer at the CDH in Zambia, Southern Africa between 2007 and 2014. We entered the term “pancreatic cancer” into the CDH database, extracted patient medical records numbers, and manually located the records for review. From each chart we extracted: age, gender, geographic origin, ethnicity, clinical features at presentations, location of tumor, stage at diagnosis and treatment. Data collection tool and master code sheet created a priori were used. Data was analyzed using statistical analysis software (SAS). Descriptive statistics including means, medians as well as frequency distributions and cross-tabulations were used. SEER database was used to compare subjects between Zambia and USA. Groups were compared using Chi-square tests and Wilcoxon Signed Rank test. A p-value less than 0.05 was used as the level of significance.
Results Thirty-eight charts were identified in the CDH dataset, of which 27 were included in final analysis and 11 excluded (5 non-pancreatic cancer diagnosis, 6 not manually located). The mean age of diagnosis was 55.7 years in the native African population, compared to 66.7 years for the African-Americans in the SEER database, p < 0.0001. There were 63.0% males (CDH) compared to 48.1% (SEER), p=0.121. Further review of the CDH database revealed that the most common presenting symptom was abdominal pain (52.6%), mode of diagnosis surgical (83%, missing 3), histopathology adenocarcinoma (86%, missing 6), location head of pancreas (83%, missing 9) and stage 4 at diagnosis (100%, missing 3). ConclusionPancreatic cancer occurs at a younger age in Zambians when compared to the African American, USA population. There is no statistically significant difference in sex presentation between Zambian and USA black population.
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Bhattacharya, Pratik, Renee Van Stavern, and Ramesh Madhavan. "Automated Data Mining: An Innovative and Efficient Web-Based Approach to Maintaining Resident Case Logs." Journal of Graduate Medical Education 2, no. 4 (December 1, 2010): 566–70. http://dx.doi.org/10.4300/jgme-d-10-00025.1.
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Abstract Background Use of resident case logs has been considered by the Residency Review Committee for Neurology of the Accreditation Council for Graduate Medical Education (ACGME). Objective This study explores the effectiveness of a data-mining program for creating resident logs and compares the results to a manual data-entry system. Other potential applications of data mining to enhancing resident education are also explored. Design/Methods Patient notes dictated by residents were extracted from the Hospital Information System and analyzed using an unstructured mining program. History, examination and ICD codes were obtained and compared to the existing manual log. The automated data History, examination, and ICD codes were gathered for a 30-day period and compared to manual case logs. Results The automated method extracted all resident dictations with the dates of encounter and transcription. The automated data-miner processed information from all 19 residents, while only 4 residents logged manually. The manual method identified only broad categories of diseases; the major categories were stroke or vascular disorder 53 (27.6%), epilepsy 28 (14.7%), and pain syndromes 26 (13.5%). In the automated method, epilepsy 114 (21.1%), cerebral atherosclerosis 114 (21.1%), and headache 105 (19.4%) were the most frequent primary diagnoses, and headache 89 (16.5%), seizures 94 (17.4%), and low back pain 47 (9%) were the most common chief complaints. More detailed patient information such as tobacco use 227 (42%), alcohol use 205 (38%), and drug use 38 (7%) were extracted by the data-mining method. Conclusions Manual case logs are time-consuming, provide limited information, and may be unpopular with residents. Data mining is a time-effective tool that may aid in the assessment of resident experience or the ACGME core competencies or in resident clinical research. More study of this method in larger numbers of residency programs is needed.
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SAMOSHCHENKO, O. V., B. S. GUSEV, and V. V. LAPKO. "MATHEMATICAL DESCRIPTION THE DIVIDE OF INTEGER NUMBERS." Scientific papers of Donetsk National Technical University. Series: Informatics, Cybernetics and Computer Science 2 - №1, no. 35-36 (2023): 85–96. http://dx.doi.org/10.31474/1996-1588-2023-1-36-85-96.
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Computer division of integers is given by polynomial transformation of complementary codes. The positive property of the mathematical model of these polynomials is characterized by the formation of polynomials of positive and negative integers with an equivalent expression. Іn the general form, the dependence of the function domain of the number’s representation in the two’s complementary code and the polynomial capacity is established. Adequate polynomial bit capacity of the complementary code dividend for defined formats of the divisor and the quotient is determined. The algorithm for determining the special polynomial of the quotient for all combinations of the operands sign polarity is formed. It is shown that the content of the quotient polynomial is determined by the partial remainder’s polarity of the dividend, which are determined by adding the transformed or untransformed complementary code of the divisor to the doubled code of the previous partial remainder complementary code. It is proved that increasing the value of the complementary code of the dividend partial remainder is reduced to a modified left shift of the dividend remainder complementary code with the loss of the sign bit. Logical expressions for fixing the overflow of the quotient are synthesized, the determination of which is combined with the calculation of the highest bit of the quotient polynomial. A reasonable algorithm for converting the calculated polynomial of the quotient into the resulting complementary code of the quotient during dividing operands with the same and different signs. For the mathematical description of the complementary code of integers, a special form of the shortened modulo-shifted code is introduced. The task of dividing integers is reduced to the operation of dividing complementary codes polynomials. In the system of complementary codes, an algorithm for determining the quotient polynomial, which is invariant to the signs of the operands, is proposed. The algorithm for calculating the correct complementary code of the dividend remainder for all combinations of the sign bits of the operands is indicated.
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Buckley, Christine, Michael S. Molloy, Alexander Hart, Amalia Voskanyan, Ritu Sarin, and Gregory Ciottone. "Hospital C.O.D.E (Clinical, Operational, Disaster, and Emergency) Terminology." Prehospital and Disaster Medicine 34, s1 (May 2019): s135—s136. http://dx.doi.org/10.1017/s1049023x19002978.
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Introduction:Healthcare facilities frequently use disaster codes as a way to communicate with employees that an emergency or incident is occurring. As increasing numbers of providers work at multiple facilities, and healthcare systems continue to build disaster response teams and protocols covering multiple facilities, standardization of disaster code terminology is critical. A lack of consistency in terminology can potentially have a devastating impact on the understanding and response of visiting or relief staff.Aim:To evaluate the level of standardization in terminology of disaster codes in healthcare facilities.Methods:A convenience sample was taken from a private Facebook™ group consisting of emergency department nurses from a wide range of facilities. The Facebook™ group was asked to share their hospital disaster codes. Of the 40,179 total members, 78 commented, including 55 photos of quick reference badges, and the rest were descriptions/lists of codes. One badge was excluded due to a blurry photograph. Results were collated and analyzed for trends and standardization.Results:The most common codes were, “Code Red” for fire (72.7%), “Code Blue” for cardiac arrest (44.9%), “Code Silver” for active shooter/weapons event (37.7%) and “Code Orange” for hazardous materials (33.8%). There were 168 instances of a code term being associated with a particular event by five or fewer facilities. Two facilities used numeric systems, with 11 using plain language descriptions.Discussion:Disaster code language is inconsistent. Few of the codes were consistently assigned to the same meaning, and none were universal. Color coding was the most common method, but there was little consistency even within color code systems. Additionally, some facilities used a combination of colors, numbers, terms, and plain language. Healthcare facilities should embrace standard terminology and create a consistent language for disaster codes to enhance response capabilities and medical security.
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Pradhan, Alisha, William Lee, Nathan Batley, Suzanne Burton, and Zoe Wyatt. "Mental Health Triage Form Use in Emergency Department Clerking – Audit at Royal Cornwall Hospital." BJPsych Open 9, S1 (July 2023): S177. http://dx.doi.org/10.1192/bjo.2023.463.
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AimsThe aim of this audit is to assess use of the Mental Health Triage Form (MHTF) at the Royal Cornwall Hospital Emergency Department (ED), during June 2021 and to determine whether MHTF use increases rates of psychiatric-specific information being documented by ED staff. Patient attendances to Accident and Emergency (A&E) departments in the UK during 2020-21 decreased by 30.3% in comparison to 2019-20. However, attendances to A&E at the Royal Cornwall Hospital (RCH) in June 2021 increased by 51.2% compared to June 2020. Psychiatric patients accounted for 2% of attendances to A&E at RCH in June 2021. The Royal College of Emergency Medicine (RCEM) have recommended use of a mental health proforma document in line with recommendations from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) document ‘Treat as One’. Based on these guidelines, the Psychiatric Liaison department at RCH have a produced a local Mental Health Triage Form (MHTF) to be used in A&E when assessing and clerking psychiatric patients.MethodsThis was a retrospective audit of clinical records of 125 mental health cases attending the Accident & Emergency Department (A&E) at Royal Cornwall Hospital during June 2021, which were referred to Psychiatric Liaison.NHS numbers were identified for each referral made during the study period. Each referral's A&E clerking documents were reviewed on an online patient records system. Information was recorded on whether each question in the Mental Health Triage Form had been answered with or without use of the form.ResultsThe Mental Health Triage Form (MHTF) was used in 44 out of 125 patients (35%). 15 patients (12%) had missing Accident & Emergency Department documentation on online records. Where the MHTF was used, there was an 25% average increase in information recorded. Over half of the questions on the MHTF were answered more when the form was used versus when it was not used.Questions relating to the patients ‘Triage Code’, which are used to determine the level of observation, urgency of referral, and appropriate place of assessment, had the highest rates of improvement using the form.ConclusionOverall use of the Mental Health Triage Form during June 2021 reduced to 35% in comparison to 46% use during June 2020. This implied that patients attending the Accident & Emergency Department at the Royal Cornwall Hospital with psychiatric presentations were not being assessed fully. This may be due to various reasons such as staff unfamiliarity with the triage form and increasing pressure on Emergency Department services.
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Parsons, C., and S. McNeill. "United Kingdom national media representations of medications used in dementia: a systematic content analysis." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i29. http://dx.doi.org/10.1093/ijpp/riac019.039.
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Abstract Introduction Newspapers contribute to public understanding and perceptions of health-related issues (1,2). Examination of news media reporting to elucidate how the public conceptualise and understand medicines use in dementia has been limited to date. Aim To investigate communication to the public about medications used in dementia via newspaper articles. Methods A systematic content analysis explored communication in the 10 highest circulated UK newspapers about medications used in dementia, over a 10-year period from 2010 to 2019. LexisNexis UK was searched using terms relating to medications and treatment in dementia (both for dementia and for other co-morbid conditions), and articles relating to medicines use in dementia were identified for inclusion. A standardised coding frame was developed, piloted, and used to code all included articles across three domains: structure (bibliographic details); content (information within each article); and judgement and rating (subjective variable related to information presented, and scored from 0-10). Where an article was linked to a scientific journal article, this was retrieved, and the content cross-checked. A second researcher independently coded a random sample (10%) of articles. Level of intercoder agreement was determined by calculation of Cohen’s kappa value. Results One hundred articles satisfied the inclusion criteria. The newspapers which most frequently contained relevant articles were: the Daily Mail (n = 33) and the Daily Express (n = 30), followed by the Daily Mirror (n = 12), the Guardian (n = 11), the Mail on Sunday (n = 5), the Sunday Express (n = 3), the i (n = 3), the Metro (n = 1), the Daily Star (n = 1) and the People (n = 1). The largest numbers of articles were published in 2011 and 2012 (n=18) and the smallest number in 2019 (n = 4), with no apparent trend observed over the study period. Main article themes were: benefits and effectiveness, risk and harm, lack of diagnosis, and funding and potential future drug developments. Starting therapy early and continuing in later stages of dementia were reported to maintain function and independence and slow decline. Antipsychotics, sedatives and opioid analgesics were considered to worsen symptoms and increase risk of death. Lack of dementia diagnosis resulted in inability to obtain dementia medication when people needed and would benefit from it. Lack of funding was highlighted as a barrier to research. Most articles were written from a clinical perspective (n=82). Half had a negative slant, 46% had a positive slant and 4% were neutral. Almost half were judged to be excellent quality (45%), 35% were considered average and 20% were judged as poor quality. Cohen’s kappa values ranged from 0.63 to 1.00, indicating satisfactory agreement between coders. Conclusion There remains scope for improvement in quality of mass media communication regarding medications used in dementia. Strengths of this study include the systematic approach employed in content analysis, while limitations include exclusion of the Sun, the Times and the Telegraph due to lack of availability of circulation figures, and exclusion of media sources other than newspapers. References (1) Akintola O, Lavis JN, Hoskins, R. Print media coverage of primary healthcare and related research evidence in South Africa. Health Res Policy Syst. 2015;13:68. (2) Stanford FC, Tauqeer Z, Kyle TK. Media and its influence on obesity. Curr Obes Rep. 2018; 7(2):186–92.
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Mårtensson, Linda, Mathilda Kovacek, Petra Holmkvist, Monika Semmrich, Carolin Svensson, Therese Blidberg, Carl Roos, et al. "725 Pre-clinical development of TNFR2 ligand-blocking BI-1808 for cancer immunotherapy." Journal for ImmunoTherapy of Cancer 8, Suppl 3 (November 2020): A768. http://dx.doi.org/10.1136/jitc-2020-sitc2020.0725.
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BackgroundThe pleiotropic TNF-alpha:TNFR axis plays a central role in the immune system. While the cellular expression of TNFR1 is broad, TNFR2 expression is mainly restricted to immune cells. The therapeutic potential of targeting TNFR2 for cancer treatment has been previously indicated and to gain further insight, we characterized a wide panel antibodies, generated from the n-CoDeR F.I.R.S.T™ target and antibody discovery platform. We identified parallel human and mouse TNFR2 specific, complete ligand (TNF-alpha) blocking antibodies and could show potent anti-tumor activity in several immune-competent models, both as single agent and in combination with anti-PD1 using a BI-1808 murine surrogate. The mechanism-of-action was shown to be FcgR dependent and likely mediated through a combination of intra-tumor T reg depletion, CD8+ T cell expansion and modulation of tumor-associated myeloid cells. These findings were confirmed using BI-1808 in a humanized mouse model.MethodsTo address safety of the human lead-candidate BI-1808 two toxicological studies were performed in cynomolgus monkeys. The first study was a dose-range-finding study and the second a GLP study where three doses (2, 20 and 200 mg/kg) were given weekly for four consecutive weeks followed by a recovery period of eight weeks. In addition, cytokine release was further studied in T cell stimulation assays and in a humanized mouse model. Moreover, the BI-1808 murine surrogate was used to study the relationship between dose, receptor occupancy (RO) and efficacy in immune competent mouse cancer experimental models.ResultsFour weekly administrations of BI-1808 to cynomolgus monkeys were well tolerated at all doses, with no associated clinical signs, and no histopathological changes. Non-adverse and reversible increases in neutrophil counts and decreases in T cells were observed at all dose levels. No drug-related adverse events were observed and consequently the NOAEL for BI-1808 was determined to be 200 mg/kg. Pharmacokinetic studies demonstrated an expected half-life of two weeks at receptor saturation. There were no indications of cytokine release in any of the systems tested. Finally, we could show that to achieve max therapeutic effect, sustained RO was needed for approximately two weeks, covering the time it takes to generate a full adaptive Immune response.ConclusionsThere is a clear association between RO and therapeutic effect and BI-1808 is well tolerated at doses associated with high and sustained RO. Collectively, these studies were used to determine the starting dose in upcoming phase I/II study in solid cancer aiming for first-patient in during December 2020.Ethics ApprovalThe study on cynomolgous monkeys was conducted by Citox/Charles River Laboratories in compliance with animal health regulations, in particular: Council Directive No. 2010/63/EU of 22 September 2010 and French decree No. 2013-118 of 01 February 2013 on the protection of animals used for scientific purposes. Studies in mice were approved by the Swedish Animal Experiment Ethics Board, ethical permit/ethical license numbers 5.2.18-17196/2018 and 5.8.18-03333/2020
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Stothard, Ellen, Mark Hickey, and Adam Wertz. "0787 Healthcare Utilization in Initiation of Oral Appliance vs Positive Airway Pressure Therapy for Sleep Apnea." Sleep 45, Supplement_1 (May 25, 2022): A341—A342. http://dx.doi.org/10.1093/sleep/zsac079.783.
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Abstract Introduction The COVID-19 pandemic and related supply chain issues have created shortages in integral components of Positive Airway Pressure (PAP) devices, the gold standard treatment for sleep apnea. Concurrently, patients have delayed care and are returning in increasing numbers. With these overlapping pressures, alternative treatments are needed. Custom-fabricated Oral Appliances (OA) are uniquely poised as a solution. However, it is unknown if initiation and treatment cost and healthcare utilization are similar to PAP or will create further disruptions at scale. Methods Patients who initiated PAP or OA therapy 2018-2020 were included. Matched visits 2017-2021 were referenced. Patients with multiple treatment initiations were excluded. Healthcare utilization quantified number visits, stratified by provider type (Physician, Physician Assistant (PA), American Board of Dental Sleep Medicine (ABDSM) Accredited Dentist, or Registered Polysomnographic Technologist (RPSGT)). Contractual amounts for CPT codes were averaged to estimate cost. Results 5172 patients, 374 received OA (7.2%). Prior to initiation, OA therapy utilized more visits on average than PAP (4.5±1.7(±SD) vs 3.5±1.9, p<0.0001). Following initiation, OA therapy utilized fewer visits than PAP (4.1±3.9 vs 5.5±4.6, p<0.0001). Specialized provider visits, i.e. dentist for OA, were lower compared to RPSGT for PAP therapy, both before and after initiation (1.4±0.8 vs 2.0±1.4 before, 1.9±1.2 vs 2.6±1.8 after, both p<0.0001). Further, prior to initiation, Physician and PA utilization was similar between OA and PAP therapies (1.4±0.8 vs 1.5±1.0 Physician, 1.1±0.8 vs 1.2±0.8 PA, both p>0.057). However, following initiation, OA therapy utilized fewer Physician visits than PAP (1.7±1.1 vs 2.1±1.7, p<0.0001) but similar PA visits (1.9±1.5 vs 2.1±1.4, p>0.5). Together, with OA dental visits estimated to be the least expensive associated visit, this analysis estimates that the provider cost of initiation of OA therapy is lower than that of PAP. Conclusion Overall, OA therapy requires less healthcare utilization, especially of providers with highest reimbursement rates. While OA requires more initial appointments, PAP therapy requires more follow up visits with specialized providers and physicians, thereby increasing cost for patients. Additional cost burden of these visits could impact patient willingness to initiate treatment. This analysis provides supportive evidence for OA as an alternative to PAP with lower treatment cost and healthcare utilization, which may provide an advantage for the already over-burdened healthcare system. Support (If Any)
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Schulz, Beckenbach, Philipp, and Hengstmann. "Farbduplexsonographische Befunde an den Leistengefäßen von Drogenabhängigen." Vasa 31, no. 1 (February 1, 2002): 7–13. http://dx.doi.org/10.1024/0301-1526.31.1.7.
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Background: During recent years increasing numbers of intravenous drug addicts with severe damage to the groin vessels were examined in our angiological ultrasound laboratory. The value of color duplex sonography for the clinical evaluation of these findings is the subject of the present study. Patients and methods: Over the course of six years every drug addict admitted to our hospital who either complained of pain or discomfort in the inguinal region or showed conspicuous clinical findings in this area was examined in our ultrasound laboratory. First by B-mode, the diameter, wall structure and compressibility of the vessels were evaluated and the surrounding tissue was checked for abnormalities. Then the blood flow of the femoral vessels was examined by color coded duplex. If an abscess was suspected, a computed tomography of the groin was obtained before surgery in most cases. Results: A total number of 77 patients was examined with pathologic results in all cases. The most frequent finding was venous thrombosis: In 63 patients complete thrombotic occlusion of the femoral vein at the injection site was observed. We registered 14 partial thromboses. 30 patients showed vessel wall alterations to variable extents in which 23 cases referred to veins and 10 cases to arteries. 7 patients showed an occlusion of the femoral artery. In 4 patients we found a false aneurysm and 3 had an arteriovenous fistula. Chronic tissue alterations were present to a certain extent in all cases rendering evaluation frequently difficult. Especially problematic to evaluation were those 34 patients where one or more surgical interventions had been performed previously. The results of an additional computed tomography had little effect on the therapeutic decisions. In 11 patients an abscess incision had to be done during the course of their hospital stay. Conclusion: Extensive damage of the groin vessels is seen in i.v. drug addicts. There is no other patient group with such a diversity of different findings. In almost every case these findings involve veins and arteries as well as the surrounding tissues.
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Wu, Lisa M., Nadia Kuprian, Krista Herbert, Ali Amidi, Jane Austin, Heiddis Valdimarsdottir, and Christine Rini. "A mixed methods analysis of perceived cognitive impairment in hematopoietic stem cell transplant survivors." Palliative and Supportive Care 17, no. 04 (September 21, 2018): 396–402. http://dx.doi.org/10.1017/s1478951518000664.
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AbstractObjectiveHematopoietic stem cell transplant (HSCT) survivors may show evidence of objective cognitive impairment; however, perceived cognitive problems and their impact on quality of life are less well-understood. The purpose of this study was to explore HSCT survivors’ perceptions of cognitive impairment and its effect on daily life functioning.MethodSixty-nine autologous and allogeneic HSCT survivors nine months to three years posttransplant experiencing mild survivorship problems completed a brief structured interview regarding perceived cognitive impairment since transplant. Data were coded and content analyzed. The frequency of participants reporting cognitive problems by domain and associations between reports of cognitive problems and age, depressed mood, anxiety, and health-related quality of life were examined.ResultOverall, 49 of the 69 participants (71%) reported cognitive impairments after transplant: 38 in memory (55%), 29 in attention and concentration (42%), and smaller numbers in other domains. There were no significant differences in problems reported by transplant type. Of the 50 participants who worked before transplant, 19 (38%) did not return to work following transplant, with 12 citing cognitive and health problems as being the reason. There were significant associations between reports of cognitive impairment and younger age (p = 0.02), depressed mood (p = 0.02), anxiety (p = 0.002), and health-related quality of life (p = 0.008).Significance of resultsA large proportion of survivors reported cognitive impairment following HSCT that impaired daily life functioning. Perceived cognitive impairment was associated with younger age, greater distress and reduced health-related quality of life.
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Perrinez, Emily, Robin Calara, Paige Schoenheit-Scott, Amelia Kenner Brininger, Lindsay L. Olson-Mack, Carol A. Reeling, Cecile Davis, et al. "Abstract P666: Covid-19 Geographic Distribution and Stroke Code Activation Within San Diego County." Stroke 52, Suppl_1 (March 2021). http://dx.doi.org/10.1161/str.52.suppl_1.p666.
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Introduction: In the early months of the COVID-19 pandemic, decreased numbers of stroke code activations were reported nationwide. In San Diego County, a diverse region that borders Mexico with over 4500 square miles and population 3.3 million, trends in COVID-19 cases varied geographically. We saw an overall decrease in stroke cases across our systems and aimed to better understand if high COVID infection rates in subregions affected stroke code activations. Methods: Stroke code activation data from 15 Stroke Receiving Centers were matched with COVID-19 case rates by patient home zip code. Patients arriving via emergency medical services (EMS) or private transportation were included. Patients with home zip codes outside of San Diego County were excluded. Data represented the cumulative rate of stroke codes and COVID-19 cases per 100,000 population per zip code for the period of March 1 through June 30, 2020. Results: We counted 1,927 stroke code activations across 106 zip codes in San Diego County. The average stroke code activation rate was 58.4 per 100,000 (range: 0-310.6) The median stroke code activation rate was 55.95 (IQR=32.1-73.1) per 100,000 population. The median COVID rate per zip code was 244.9 (IQR=177-448.4) per 100,000 population. There were 958 (49.7%) non-stroke diagnoses, 576 (29.9%) AIS, 272 (14.1%) TIA, 104 (5.4%) ICH and 17 (.9%) SAH. We did not identify a correlation between stroke code activation rates and COVID rates across zip codes (r=.17, p=.09, 95% CI(-.02, .35)). Conclusions: Across a large and diverse single-county region, no correlation was found between COVID positivity rate per zip code and stroke code activations. We found no decreases in stroke code activations in areas with high COVID rates.
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"Fourth Digit Code Number for Groups 5–11." Cephalalgia 8, no. 7_suppl (July 1988): 42–43. http://dx.doi.org/10.1111/j.1468-2982.1991.tb00026.x.
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Labin, Edward, Dawn M. Meyer, Benjamin Shifflett, Brett C. Meyer, and Royya F. Modir. "Abstract P689: Do Cyclic Patterns of Stroke Code Activation Occur in a Comprehensive Stroke Center?" Stroke 52, Suppl_1 (March 2021). http://dx.doi.org/10.1161/str.52.suppl_1.p689.
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Background: The effects of circadian rhythm on stroke can include increases in morning heart rate, blood pressure, catecholamines, platelet aggregation, and hypercoagulability and might correlate with higher numbers of morning strokes. We assessed time of day and frequency of stroke code activation for a potential role of circadian rhythm in stroke risk. Methods: A retrospective analysis of prospectively collected data from an IRB approved stroke registry, from July 2004 to July 2020, was performed. Codes were included where stroke codes were activated with last known well (LKW) <6 hours to limit the effect of wake-up strokes and equalize changing practice patterns over time. Subjects were divided into four epochs based on code activation: Night (00:00-05:59), Morning (06:00-11:59), Afternoon (12:00-17:59), and Evening (18:00-23:59). Confirmed diagnosis of stroke, baseline blood pressure (SBP & DBP), heart rate (HR), and PTT were compared. Chi squared was used to compare categorical data and t test for continuous. Results: A total of 5,366 subjects were identified. Stroke code activations differed across epochs (Night n=312, 5.81%; Morning n=1439, 26.82%; Afternoon n=2207, 41.13%; Evening n=1408, 26.24%: p<0.0001). In the subset analysis of true strokes, activations also differed across epochs (Night n=125, 5.26%; Morning n= 831, 34.95%; Afternoon n=934, 39.28%; Evening n=488, 20.52%: p<0.0001). Overall, SBP was different with Evening highest and Morning lowest (x 151.6, x 148.2;p=0.01). Overall DBP showed Night highest and Afternoon lowest (x 83.9, x 81;p=0.002). Heart rate showed Night highest and Morning lowest (x 84.9, x 81.6;p=0.002). Conclusions: This study found that most stroke code activations occur in Afternoons at this CSC. This may be due to patient level characteristics, bystander availability, or other factors. Future studies should assess multi-center data and include other circadian rhythm biomarkers.
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Chang, Tiffany, Judith Lichtman, Larry Goldstein, and Mary George. "Abstract WP288: Variations in the Reliability of ICD-9-CM Codes by Hospital Characteristics and Stroke Severity: The Paul Coverdell National Acute Stroke Program." Stroke 47, suppl_1 (February 2016). http://dx.doi.org/10.1161/str.47.suppl_1.wp288.
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Background: ICD-9-CM codes recorded in administrative databases are often used to identify patients with specific clinical conditions. We determined if there are variations in the accuracy of stroke and transient ischemic attack (TIA) ICD-9-CM codes based on hospital characteristics and stroke severity. Methods: We used the records of patients discharged from hospitals in the Paul Coverdell National Acute Stroke Program in 2013. Diagnosis categories included ischemic stroke, TIA, subarachnoid hemorrhage, and intracerebral hemorrhage. We compared the agreement between the principal ICD-9-CM code and attending physician’s clinical diagnosis. The effects of hospital characteristics and stroke severity (National Institutes of Health Stroke Scale score, NIHSS) on percent agreement were assessed. Results: Among 67,442 patient records with hospital characteristic data, agreement between ICD-9-CM codes and the clinical diagnosis for ischemic stroke was higher for hospitals with stroke units, stroke teams, larger numbers of beds, and locations in metropolitan areas (P<0.05) (Table). For 55,373 records with a documented NIHSS at admission, agreement was lower for mild ischemic strokes (NIHSS 0-7) compared with more severe strokes (P<0.001); disagreements were commonly due to the patient having a carotid endarterectomy (potentially reflecting continuity of care for a stroke event) or TIA rather than a stroke. Conclusion: Systematic variations in the accuracy of ICD-9-CM codes by hospital characteristics and stroke severity may affect case identification in epidemiologic studies and have implications for hospital-level quality metrics.
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Abdul Razak, Tariq, and Abdurezak Abdulahi Hashi. "Ethical Responses to Modern Clinical Trials on Human Subjects: A Comparative Perspective." IIUM Medical Journal Malaysia 17, no. 2 (December 14, 2018). http://dx.doi.org/10.31436/imjm.v17i2.951.
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With the modern advances and technological breakthroughs in biomedicine, scientific experiments involving human subjects had increased. Since the American gynecologist Marion Sims (d.1883), who conducted a scientific research on some selected African women suffering from prolapsed uterus disease, or American physician Walter Reed’s (d.1902) team who gave germs of yellow fever to 22 human subjects to test if fever is transmitted by particularly mosquito species, as well as the Tuskegee Syphilis Study that was conducted from 1932 until 1972, or the scientific experiments conducted by Nazis of Germany on large numbers of prisoners, clinical trials on human subjects have become part of the scientific activities. These and many other scientific experiments conducted on human subjects had shown the extent of potential threats of unregulated scientific experiments on human life. Serious moral and legal concerns are then raised towards the morality of these activities. These concerns covered four major areas; safety, sanctity of the human body, consent and validity of experiment. This paper uses textual and analytical methods and aims to review Muslim jurists’ opinions on the permissibility of conducting clinical researches that uses human subjects. The opinions of the Muslim jurists are then compared to that of bioethical codes and declarations such as the Nuremberg Code, coined in (1947) and the Helsinki Declaration that was formulated by World Medical Organization in 1964. Fiqh and legal literature on this subject is exposed, and the moral contents of such writings are analyzed. The study is expected to come up with a comparative account of conventional and Islamic responses to modern clinical trials on human subjects.
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"Keratosis Pilaris: Clinical Features, Clinical Course, and Treatment Satisfaction in Thai Patients." Journal of the Medical Association of Thailand 106, no. 1 (January 15, 2023): 20–28. http://dx.doi.org/10.35755/jmedassocthai.2023.01.13729.
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Background: Keratosis pilaris (KP) is a chronic, occasionally relapsing skin disease that has long-term physical and mental health impacts in Thai patients. Objective: To study skin rash characters, clinical course, treatment satisfaction, and quality of life in Thai patients with KP. Materials and Methods: Patients were recruited at the skin clinic of a 700-bed regional hospital between July 2020 and December 2021. Clinical presentation and course were recorded at enrollment. Dermatologist thoroughly examined the cutaneous lesions. Patients answered the Thai version of the Dermatology Life Quality Index (DLQI) questionnaire at enrollment and then, recorded treatment satisfaction and response to the same DLQI questionnaire at one and three months after receiving the standard treatment. The present study was approved by the IRB, Pranangklao Hospital (code ID 6206). Results: One hundred sixty-four KP patients with 69.5% female, completed the present study. Patients visited skin clinic due to rash of KP at enrollment in 47 female (41.2%) and 23 male (46%). Severity of KP was perceived as stable or worsen in 46 female (40.4%) and 22 male (44%). Age onset of KP was most common in the second decade for 43.9%. The lesions appeared most frequently on calves for 64%. Patients with high, normal, and low BMI had skin rash presented in 19%, 17%, and 15% of their body surface area, and the numbers of papule on average was 5, 5, and 3.5 per square centimeter, respectively. Forty-eight cases (29.3%) suffered poor quality of life, which was improved after receiving standard treatment. Conclusion: Clinical features and course of KP in most Thai patients were similar to international studies. However, rash appeared more commonly in the calves of Thai patients. Standard treatment improved patients’ satisfactions and quality of life at 1- and 3-month follow-up. Keywords: Keratosis pilaris; Clinical features; Treatment satisfaction; Dermatologic Life Quality Index; Quality of life
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Gallofre, Miquel, Sònia Abilleira, Josep Argimon, and Carles Constante. "Abstract W P219: Enhancing Delivery of Reperfusion Therapies for Ischemic Stroke: Towards Equity Through Organization." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.wp219.
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Introduction: Delays in hospital arrival are the most relevant impediment to effective dissemination of thrombolysis. Organization is crucial to overcome such difficulties. Objective: to report on the achievements of a region-wide organized stroke network in terms of numbers of acute stroke patients assessed by stroke experts, numbers of patients treated with any reperfusion therapy and their geographical distribution, and clinical outcomes. Methods: In mid 2006 the government-based Stroke Program (SP) of Catalonia (7.5 millions) established a regionalized system of acute stroke care (Stroke Code System, SCS) that involves professionals and health administrators. Any acute stroke patient must be referred to the nearest referral hospitals, currently including 14 PSC and 11 community hospitals connected to the telestroke network covered by a centralized, 24-hour, on-call service made up with vascular neurologists. As for stroke admissions, the Hospital Discharge Database is used. Telestroke-based assessments are included in the TICat registry and reperfusion therapies are notified to the government-mandated SONIIA registry. In both registries completeness is guaranteed by SP. Results: Since dissemination of the SCS, numbers of stroke patients undergoing timely expert assessment have gradually increased: from 2,000 in 2006 to 4,800 assessments in 2013 (20% and 44% of all stroke admissions, respectively). Similarly, numbers of IV thrombolysis have risen from 329 in 2006 to 1,106 in 2013. In the areas primarily covered by telestroke hospitals, the population thrombolysis rate reached 13*100,000 in 2013. Overall, the population reperfusion treatment rate increased from 4.6*100,000 in 2006 to 14.5*100,000 in 2013, with some hospitals and their catchment areas achieving rates over 20*100,000. As for clinical outcomes, reperfusion therapies are safe and effective and metrics improve over time. IV thrombolysis has been mapped out to show a clear territorial dissemination (2005 on). Conclusion: Regionalization and organization of the SCS has had a quantifiable and favorable effect in terms of numbers of acute stroke patients receiving early diagnosis and specific reperfusion therapies, as well as clinical outcomes.
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Cui, Zhe, Ya Cui, Yan Gao, Tao Jiang, Tianyi Zang, and Yadong Wang. "Enhancement and Imputation of Peak Signal Enables Accurate Cell-Type Classification in scATAC-seq." Frontiers in Genetics 12 (April 6, 2021). http://dx.doi.org/10.3389/fgene.2021.658352.
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Single-cell Assay Transposase Accessible Chromatin sequencing (scATAC-seq) has been widely used in profiling genome-wide chromatin accessibility in thousands of individual cells. However, compared with single-cell RNA-seq, the peaks of scATAC-seq are much sparser due to the lower copy numbers (diploid in humans) and the inherent missing signals, which makes it more challenging to classify cell type based on specific expressed gene or other canonical markers. Here, we present svmATAC, a support vector machine (SVM)-based method for accurately identifying cell types in scATAC-seq datasets by enhancing peak signal strength and imputing signals through patterns of co-accessibility. We applied svmATAC to several scATAC-seq data from human immune cells, human hematopoietic system cells, and peripheral blood mononuclear cells. The benchmark results showed that svmATAC is free of literature-based markers and robust across datasets in different libraries and platforms. The source code of svmATAC is available at https://github.com/mrcuizhe/svmATAC under the MIT license.