Application of optical character recognition with natural language processing for large-scale quality metric data extraction in colonoscopy reports

Background and AimsColonoscopy is commonly performed for colorectal cancer screening in the United States. Reports are often generated in a non-standardized format and are not always integrated into electronic health records. Thus, this information is not readily available for streamlining quality management, participating in endoscopy registries, or reporting of patient- and center-specific risk factors predictive of outcomes. We aim to demonstrate the use of a new hybrid approach using natural language processing of charts that have been elucidated with optical character recognition processing (OCR/NLP hybrid) to obtain relevant clinical information from scanned colonoscopy and pathology reports, a technology co-developed by Cleveland Clinic and eHealth Technologies (West Henrietta, NY, USA).MethodsThis was a retrospective study conducted at Cleveland Clinic, Cleveland, Ohio, and the University of Minnesota, Minneapolis, Minnesota. A randomly sampled list of outpatient screening colonoscopy procedures and pathology reports was selected. Desired variables were then collected. Two researchers first manually reviewed the reports for the desired variables. Then, the OCR/NLP algorithm was used to obtain the same variables from 3 electronic health records in use at our institution: Epic (Verona, Wisc, USA), ProVation (Minneapolis, Minn, USA) used for endoscopy reporting, and Sunquest PowerPath (Tucson, Ariz, USA) used for pathology reporting.ResultsCompared with manual data extraction, the accuracy of the hybrid OCR/NLP approach to detect polyps was 95.8%, adenomas 98.5%, sessile serrated polyps 99.3%, advanced adenomas 98%, inadequate bowel preparation 98.4%, and failed cecal intubation 99%. Comparison of the dataset collected via NLP alone with that collected using the hybrid OCR/NLP approach showed that the accuracy for almost all variables was >99%.ConclusionsOur study is the first to validate the use of a unique hybrid OCR/NLP technology to extract desired variables from scanned procedure and pathology reports contained in image format with an accuracy >95%.     

Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies.

OBJECTIVE: To compare the obstetric outcome of in vitro fertilization pregnancies with normally conceived pregnancies. STUDY DESIGN: The obstetric outcome of in vitro fertilization pregnancies achieved in 763 British residents at two in vitro fertilization clinics resulting in the births of 961 babies were compared by means of the relative risk statistic with a control group of naturally conceived primiparous pregnancies matched by maternal age and multiplicity of pregnancy. RESULTS: Twenty-five percent of in vitro fertilization pregnancies were multiple pregnancies. The incidence of singleton term breech presentation was similar to that among controls. As compared with controls there was an increased incidence among in vitro fertilization pregnancies of vaginal bleeding and hypertension requiring hospitalization (p less than 0.001) and cesarean births (p less than 0.001) and, among in vitro fertilization singleton pregnancies, an increased incidence of intrauterine growth retardation (p less than 0.05), placenta previa (p less than 0.05), and preterm delivery (p less than 0.001). The congenital malformation, stillbirth, and perinatal mortality rates were comparable with maternal age-standardized national rates. CONCLUSIONS: Although the majority of in vitro fertilization pregnancies have a satisfactory obstetric outcome, there are a number of increased obstetric risks that may reflect the history of infertility, the relatively high incidence of poor obstetric history, and the lower threshold for obstetric intervention in in vitro fertilization patients.     

Evaluating the quality of teaching in medical education: are we using the evidence for both formative and summative purposes?

Heightened focus on the quality of teaching in medical schools has led to increased use of student surveys as a means of evaluating teaching. In some institutions, however, the summative purpose is emphasized over the developmental or self-improvement objective. The aim of this study was to examine the utility of a student evaluation of teaching questionnaire for use in administrative decision making (summative purpose) and in identification of faculty whose instruction needs improvement (formative purpose). Results of this analysis are discussed in addition to related issues regarding faculty development and the importance of adopting multiple methods of evaluating and documenting teaching and other educational activity.     

Low peak bone mineral density in healthy Lebanese subjects

Osteoporosis is a major public health problem in Western countries and is projected to have a similar impact in the Middle East. It has been suggested that peak bone mineral density (BMD), a major determinant of osteoporotic fractures later in life, may be lower in this part of the world compared with the Western world. However, subjects have not been randomly selected or systematically screened to rule out secondary causes of bone loss. The purpose of this study was to determine peak bone mass and lifestyle risk factors for bone loss in a randomly chosen sample of healthy Lebanese subjects from the greater Beirut area. Subjects 25-35 years of age were randomly selected from greater Beirut, which comprises one third of the Lebanese at large, and studied during the Fall of 1999. BMD was measured at the lumbar spine, hip, forearm, and total body. A questionnaire on lifestyle factors was administered to all subjects. Results were compared with the database of subjects from the USA provided by the manufacturer, and to the NHANES database for the total hip. Two hundred thirteen subjects were studied; 45 subjects rotated at all three centers for cross-calibration purposes. Peak BMD in Lebanese subjects was 0.2-0.9 SD below that of peak BMD in American subjects, depending on skeletal site, gender, and densitometer. These differences persisted after attempting to adjust for body size. Osteoporosis and osteopenia were more prevalent than in healthy young Americans. Height, weight, and total body fat were the most significant correlates of BMD/bone mineral content (BMC), accounting for 0.3-0.7 of the variance in bone mass measurement. Lifestyle factors had a very modest but significant contribution to bone mass variance. This is the first population-based study from the Middle East demonstrating that peak BMD is slightly lower in Lebanese subjects compared as with an established database from the USA. Due to the selection of relatively healthier subjects in our study than in the NHANES study, the actual differences between the two populations may be even greater. The impact of our findings on the epidemiology of osteoporotic fractures in Lebanon remains to be determined.     

The alpha2-adrenoceptor antagonist dexefaroxan enhances hippocampal neurogenesis by increasing the survival and differentiation of new granule cells.

The generation of new neurons in the hippocampus is a dynamic process regulated by environmental, endocrine, and pharmacological factors. Since enhancement of hippocampal neurogenesis has been associated with learning and memory, and the locus coeruleus-noradrenergic system has been shown to modulate these cognitive functions, we hypothesized that activation of noradrenergic neurotransmission might enhance neurogenesis in the adult hippocampus. To test this hypothesis in vivo, we induced the release of noradrenaline in the hippocampus by blocking presynaptic inhibitory autoreceptors with the selective alpha2-adrenoceptor antagonist dexefaroxan. Confocal microscopy showed that noradrenergic afferents make contact with proliferating and differentiating cells, suggesting a direct noradrenergic influence on neurogenesis. Chronic systemic treatment of rats with dexefaroxan did not affect cell proliferation per se in the dentate gyrus (as monitored by bromodeoxyuridine-labeling), but promoted the long-term survival of newborn neurons by reducing apoptosis. Dexefaroxan treatment also enhanced the number and complexity of the dendritic arborizations of polysialated neural cell adhesion molecule-positive neurons. The trophic effects of dexefaroxan on newborn cells might involve an increase in brain-derived neurotrophic factor, which was upregulated in afferent noradrenergic fiber projection areas and in neurons in the granule cell layer. By promoting the survival of new endogenously formed neurons, dexefaroxan treatment represents a potential therapeutic strategy for maintaining adult neurogenesis in neurodegenerative conditions, such as Alzheimer's disease, that affect the hippocampus.