Under-documentation of chronic kidney disease in the electronic health record in outpatients

Objective

To ascertain if outpatients with moderate chronic kidney disease (CKD) had their condition documented in their notes in the electronic health record (EHR).

Design

Outpatients with CKD were selected based on a reduced estimated glomerular filtration rate and their notes extracted from the Columbia University data warehouse. Two lexical-based classification tools (classifier and word-counter) were developed to identify documentation of CKD in electronic notes.

Measurements

The tools categorized patients'' individual notes on the basis of the presence of CKD-related terms. Patients were categorized as appropriately documented if their notes contained reference to CKD when CKD was present.

Results

The sensitivities of the classifier and word-count methods were 95.4% and 99.8%, respectively. The specificity of both was 99.8%. Categorization of individual patients as appropriately documented was 96.9% accurate. Of 107 patients with manually verified moderate CKD, 32 (22%) lacked appropriate documentation. Patients whose CKD had not been appropriately documented were significantly less likely to be on renin-angiotensin system inhibitors or have urine protein quantified, and had the illness for half as long (15.1 vs 30.7 months; p<0.01) compared to patients with documentation.

Conclusion

Our studies show that lexical-based classification tools can accurately ascertain if appropriate documentation of CKD is present in a EHR. Using this method, we demonstrated under-documentation of patients with moderate CKD. Under-documented patients were less likely to receive CKD guideline recommended care. A tool that prompts providers to document CKD might shorten the time to implementing guideline-based recommendations.     

Induction of latency-associated peptide (transforming growth factor-β(1)) expression on CD4+ T cells reduces Toll-like receptor 4 ligand-induced tumour necrosis factor-α production in a transforming growth factor-β-dependent manner

CD4(+) T cells expressing the latent form of transforming growth factor-β [latency-associated peptide (LAP) (TGF-β(1))] play an important role in the modulation of immune responses. Here, we identified a novel peptide ligand (GPC(81-95) ) with an intrinsic ability to induce membrane-bound LAP (TGF-β(1)) expression on a subpopulation of human CD4(+) T cells (using flow cytometry; ranging from 0·8% to 2·6%) and stimulate peripheral blood mononuclear cells to release LAP (TGF-β(1) ) (using ELISPOT assay; ranging from 0·03% to 0·16%). In spite of this low percentage of responding cells, GPC(81-95) significantly reduced Toll-like receptor 4 ligand-induced tumour necrosis factor-α production in a TGF-β(1) - and CD4(+) T-cell-dependent manner. The results demonstrate that GPC(81-95) is a useful tool to study the functional properties of a subpopulation of LAP (TGF-β(1))(+) CD4(+) T cells and suggest a pathway that can be exploited to suppress inflammatory response.     

Genetic characterization of two low pathogenic avian influenza virus H5N1 isolates from Ontario, Canada

Genomes of two low pathogenic H5N1 avian influenza (LPAI) viruses, A/Turkey/ON/84/1983 and A/Mallard/ON/499/2005 from Ontario, Canada were cloned and genetically characterized. Phylogenetic analysis showed that the Canadian isolates cluster with other North American AIVs and are distinct from the Euro-Asian H5N1 isolates. Individual gene comparisons demonstrated that the Ontario isolates were most similar to the viruses isolated from around the same time period and geographical area. A long deletion of 22 amino acids was identified in the stalk region of NA of A/Turkey/ON/84/1983 isolate, a characteristic mutation related to its adaptation to domestic birds. To our knowledge A/Turkey/ON/84/1983 genomic sequence is the first and only available entire genomic sequence of a H5N1 AIV from domestic birds in Canada and USA. This work is a joint collaboration between the principal investigators Davor Ojkic and Shayan Sharif.     

Evaluation serum levels of Insulin Growth Factor-1 (IGF-1) and its association with clinical parameters in severe COVID-19

Inflammopharmacology - Severe coronavirus disease-2019 (COVID-19) is associated with dysregulated immune response and extreme inflammatory injury. Considering the role of insulin growth factor-1...     

Prevalence of mucosal types of human papillomavirus in skin lesions in north part of Iran

Human papillomaviruses (HPVs) consist of more than 100 types and are known to be associated with numerous malignant tumors, including carcinomas of the mucosal and cutaneous epithelium. Non-melanoma skin cancer (NMSC) is the most frequently occurring malignancy worldwide in the Caucasian population. Some studies have shown that NMSC biopsy specimens harbor cutaneous as well as mucosal human papillomavirus, suggesting that mucosal types may play a role in development and progression of the tumor in skin. To investigate the presence of mucosal HPV types in skin lesions, we performed a retrospective study in which 288 paraffin embedded biopsies from benign and malignant skin lesions (NMSC) were collected. Using nested PCR with MY09/11 and GP5+/6+ primers mucosal HPVs were detected in 25.7% of malignant specimens, but just in 0.7% of benign lesions. Direct sequencing revealed HPV18 as the most frequent type, which was found in 75% of HPV-positive specimens. HPV16 and HPV56 were also detected, 22.3 and 2.7%, respectively. These findings suggest that, high-risk mucosal HPV types recently identified as significant risk factors for cervical cancer, may also represent a risk factor for non-melanoma skin cancer.     

Age- and sex-specific morphologic changes in the metaphyseal fossa adjacent to epiphyseal tubercle in children and adolescents without hip disorders

The epiphyseal tubercle plays an important role in epiphyseal stabilization. While the majority of studies have focused on tubercle morphology, there is a paucity of information on the morphological features of the metaphyseal fossa, where the tubercle sits on the metaphysis. The goal of this study was to determine the developmental changes in the capital femoral metaphyseal fossa. Computed tomography of the pelvis from 80 children and adolescents 8-15 years old were used to create three-dimensional models of the proximal femur. Depth, width, length, and surface area of the metaphyseal fossa were measured and the impact of age and sex on fossa morphology was assessed using the linear regression and two-way analysis of variance, respectively. The metaphyseal fossa was located in the posterosuperior quadrant of the metaphysis without any variations in the location with increasing age (P > .1). However, with increasing age, there was a reduction in all metaphyseal fossa measurements including the depth, length, width, and surface area (P < .01). No significant differences were noted for the metaphyseal fossa measurements between males and females (P > .1). The metaphyseal fossa reduces in size from 8 to 15 years of age in a similar fashion in males and females. As the metaphyseal fossa adjacent to the tubercle matches the area where a focal radiolucency has been observed in early slipped capital femoral epiphysis (SCFE), further studies should clarify the mechanisms by which the interlocking interaction of the epiphyseal tubercle and its fossa contributes to or is affected by SCFE.