Automatic identification of heart failure diagnostic criteria,using text analysis of clinical notes from electronic health records

ObjectiveEarly detection of Heart Failure (HF) could mitigate the enormous individual and societal burden from this disease. Clinical detection is based, in part, on recognition of the multiple signs and symptoms comprising the Framingham HF diagnostic criteria that are typically documented, but not necessarily synthesized, by primary care physicians well before more specific diagnostic studies are done. We developed a natural language processing (NLP) procedure to identify Framingham HF signs and symptoms among primary care patients, using electronic health record (EHR) clinical notes, as a prelude to pattern analysis and clinical decision support for early detection of HF.DesignWe developed a hybrid NLP pipeline that performs two levels of analysis: (1) At the criteria mention level, a rule-based NLP system is constructed to annotate all affirmative and negative mentions of Framingham criteria. (2) At the encounter level, we construct a system to label encounters according to whether any Framingham criterion is asserted, denied, or unknown.MeasurementsPrecision, recall, and F-score are used as performance metrics for criteria mention extraction and for encounter labeling.ResultsOur criteria mention extractions achieve a precision of 0.925, a recall of 0.896, and an F-score of 0.910. Encounter labeling achieves an F-score of 0.932.ConclusionOur system accurately identifies and labels affirmations and denials of Framingham diagnostic criteria in primary care clinical notes and may help in the attempt to improve the early detection of HF. With adaptation and tooling, our development methodology can be repeated in new problem settings.     

Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: Design and pilot study in nursing home residents

Study aimThe aim of this study was to develop a Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD), to psychometrically evaluate and pilot test the instrument in nursing homes. Comparable to the MDS for pressure ulcers, the MDS-IAD aims to collect epidemiological data and evaluate the quality of care.Materials and methodsAfter designing and content/face validation by experts and clinicians, staff nurses assessed 108 residents (75.9% female, 77.8% double incontinent) in a convenience sample of five wards. A second nurse independently assessed fifteen residents to calculate inter-rater agreement (p₀) and reliability [Cohen's Kappa (ĸ)].ResultsThe ĸ-value for ‘urinary incontinence’ was 0.68 [95% confidence interval (CI) 0.37–0.99] and 0.55 (95% CI 0.27–0.82) for ‘faecal incontinence’. The p₀ for severity categorisation according to the Ghent Global IAD Categorisation Tool (GLOBIAD) was 0.60. IAD was diagnosed in 21.3% of the residents. IAD management mainly involved the application of a leave-on product (66.7%), no-rinse foams (49.1%), toilet paper (47.9%), and water and soap (38.8%). Fully adequate prevention or treatment was provided to respectively 3.6% and 8.7% of the residents.ConclusionThis instrument provides valuable insights in IAD prevalence at organisational level, will allow benchmarking between organisations, and will support policy makers. Future testing in other healthcare settings is recommended.     

Long-term clinical and radiological outcomes of anterior uncoforaminotomy for unilateral single-level cervical radiculopathy: retrospective cohort study

BACKGROUND CONTEXTAnterior cervical discectomy and fusion is a common procedure for degenerative cervical radiculopathy. In 1996, Dr. H.D. Jho reported an operative technique allowing nerve root decompression via anterior uncoforaminotomy whereas avoiding fusion.PURPOSETo assess long-term clinical and radiological outcomes of anterior uncoforaminotomy in patients with degenerative cervical spine pathology.STUDY DESIGNA single clinic, retrospective cohort study.PATIENT SAMPLEAdult patients who underwent anterior uncoforaminotomy from 2013 to 2018.OUTCOME MEASURESClinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters included sagittal balance, disc height and White anPanjabi criterion.MATERIALS AND METHODSAll patients underwent unilateral single-level anterior uncoforaminotomy, and long-term clinical and radiologic follow up was carried out. Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters evaluated included sagittal balance, disc height and White and Panjabi criteria (3.5 mm of translation, 11 degrees of kyphosis). The mean follow-up period was 33.3 ± 10.6 months (range 12–57 months).RESULTSAll measures of clinical outcome improved. VAS (neck) and VAS (arm) decreased 3 [2; 4] and 5 [3; 5.2] points (median [interquartile range]), respectively (p<0.001); NDI improved from 0.38 [0.36; 0.4], to 0.29 [0.22; 0.34] (p<0.001). Two patients (6%) required additional surgery one year after operation. There were no complications in the perioperative period. Disc height decreased 0.8 mm [0.1; 2.1] (p<0.001). All patients retained stability of the cervical spine based on White and Panjabi criteria. Sagittal balance parameters did not change significantly.CONCLUSIONUncoforaminotomy is an effective and safe method to decompress a unilateral single-level nerve root in degenerative cervical radiculopathy whereas preserving anatomy and motion of the cervical spine.     

Predicting the long-term impact of rotavirus vaccination in 112 countries from 2006 to 2034: A transmission modeling analysis

Rotavirus vaccination has been shown to reduce rotavirus burden in many countries, but the long-term magnitude of vaccine impacts is unclear, particularly in low-income countries. We use a transmission model to estimate the long-term impact of rotavirus vaccination on deaths and disability adjusted life years (DALYs) from 2006 to 2034 for 112 low- and middle-income countries. We also explore the predicted effectiveness of a one- vs two- dose series and the relative contribution of direct vs indirect effects to overall impacts. To validate the model, we compare predicted percent reductions in severe rotavirus cases with the percent reduction in rotavirus positivity among gastroenteritis hospital admissions for 10 countries with pre- and post-vaccine introduction data. We estimate that vaccination would reduce deaths from rotavirus by 49.1 % (95 % UI: 46.6–54.3 %) by 2034 under realistic coverage scenarios, compared to a scenario without vaccination. Most of this benefit is due to direct benefit to vaccinated individuals (explaining 69–97 % of the overall impact), but indirect protection also appears to enhance impacts. We find that a one-dose schedule would only be about 57 % as effective as a two-dose schedule 12 years after vaccine introduction. Our model closely reproduced observed reductions in rotavirus positivity in the first few years after vaccine introduction in select countries. Rotavirus vaccination is likely to have a substantial impact on rotavirus gastroenteritis and its mortality burden. To sustain this benefit, the complete series of doses is needed.     

The effect of salt-water bath in the management of treatment-related peripheral neuropathy in cancer patients receiving taxane and platinum-based treatment

ObjectivesIn a clinical setting, patients have been observed to complain of discomfort and to discontinue treatment because of chemotherapy-induced peripheral neuropathy. This experimental study was conducted to determine the effect of a salt-water bath in the management of chemotherapy-induced peripheral neuropathy.MethodOne hundred and three patients who received taxane and platinum-based chemotherapy due to cancer and developed peripheral neuropathy associated with the treatment between December 2018 and June 2020 were included in the study. The patients were assigned to the control and experimental groups (1-warm salt-water and 2-cold salt-water) following the randomization checklist. While control groups did not receive any interventions, the patients in the salt-water group were asked to apply warm (41 °C) or cold-water (23–26 °C) baths to their hands/feet for 30 min every other day for 14 days. The data were collected at the beginning of the study and at the end of its first and second weeks using the Patient Information Form and National Cancer Institute (NCI)-CTCAE v5.0 toxicity criteria as well as the EORTC QLQ-C30 and EORTC QLQ-CIPN20 quality of life scales.ResultsThe patients had a mean age of 55.6 ± 10.3, and most of them were treated following a breast cancer diagnosis. At the beginning of the study, Grade 3 peripheral neuropathy severity and quality of life scores of the cold/warm salt-water and control groups were similar. Due to repeated follow-ups, it was determined that the peripheral neuropathy severity decreased and the quality of life scores increased statistically significantly in the patients in the cold salt-water bath group compared to the control group.ConclusionThis study's results suggest that a cold salt-water bath can be an effective approach in managing the development of peripheral neuropathy due to taxane and platinum-based treatment.     

The geographic harmonisation of Scotland's small area census data, 1981 to 2011

Previous research in Scotland used a merging approach to combine census boundary data for geographies specific to 1981, 1991 and 2001 to create Consistent Areas Through Time (CATTs) for the analysis of health and social data for small areas. In this paper, we adopt the same methodology to integrate the 2011 Scottish Output Areas to the CATTs. First, we overlaid the 2001 Output Areas upon the 2011 Output Areas to create SUPER OAs, which were then combined with SUPER EDs, which represented a consistent small area geography for 1981 and 1991. This resulted in 8,548 CATTs providing a consistent geography for the 1981, 1991, 2001 and 2011 Censuses in Scotland. We demonstrate the utility of the CATTs by exploring the correlations between deprivation, the proportion of the population who were permanently sick and those with degree qualifications, across the 4 censuses, a research angle impossible without consistent geographies. We have provided a resource that enables users to deepen their understanding of small area social changes in Scotland between the 1981 and 2011 Censuses.