The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies

Our objective was to undertake a systematic review ascertaining the accuracy of using administrative healthcare data to identify epilepsy cases. We searched MEDLINE and Embase from 01/01/1975 to 03/07/2018 for studies evaluating the diagnostic accuracy of routinely collected healthcare data in identifying epilepsy cases. Any disease coding system in use since the International Classification of Diseases, Ninth Revision (ICD-9) was permissible. Two authors independently screened studies, extracted data, and quality-assessed studies. We assessed positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity. The primary analysis was a narrative synthesis of review findings. Thirty studies were included, published between 1989 and 2018. Risks of bias were low, high, and unclear in 4, 14, and 12 studies, respectively. Coding systems included ICD-9, ICD-10, and Read Codes, with or without antiepileptic drugs (AEDs). PPVs included ranges of 5.2%–100% (Canada), 32.7%–96.0% (USA), 47.0%–100% (UK), and 37.0%–88.0% (Norway). Sensitivities included ranges of 22.2%–99.7% (Canada), 12.2%–97.3% (USA), and 79.0%–94.0% (UK). Nineteen studies contained at least one algorithm with a PPV >80%. Sixteen studies contained at least one algorithm with a sensitivity >80%. PPV was highest in algorithms consisting of disease codes (ICD-10 G40-41, ICD-9 345) in combination with one or more AEDs. The addition of symptom codes to this (ICD-10 R56; ICD-9 780.3, 780.39) lowered PPV. Sensitivity was highest in algorithms consisting of symptom codes with one or more AEDs. Although using AEDs alone achieved high sensitivities, the associated PPVs were low. Most NPVs and specificities were >90%. We conclude that it is reasonable to use administrative data to identify people with epilepsy (PWE) in epidemiological research. Studies prioritizing high PPVs should focus on combining disease codes with AEDs. Studies prioritizing high sensitivities should focus on combining symptom codes with AEDs. We caution against the use of AEDs alone to identify PWE.     

How can we best use opportunities provided by routine maternity care to engage women in improving their diets and health?

Pregnancy provides motivation for women to improve their diets and increase their physical activity. Opportunistic brief interventions delivered as part of routine primary care have produced improvements in patients' health behaviour. Consequently, there have been calls for midwives to use contacts during pregnancy in this way. This study explored the experiences of pregnant women and research midwives/nurses of a brief intervention called Healthy Conversation Skills (HCS) being delivered as part of a randomised control trial, assessing the acceptability and feasibility of including this intervention in routine maternity care. Three research questions were addressed using mixed methods to produce four datasets: face‐to‐face interviews with participants, a focus group with the HCS‐trained midwives/nurses, case reports of participants receiving HCS and audio‐recordings of mid‐pregnancy telephone calls to the women which produced midwife/nurse HCS competency scores. Midwives/nurses used their HCS to support women to make plans for change and set goals. Women welcomed the opportunity to address their own health and well‐being as distinct from that of their baby. Midwives/nurses were competent in using the skills and saw healthy conversations as an effective means of raising issues of diet and physical activity. Recent extension of maternity appointment times provides ideal opportunities to incorporate a brief intervention to support behaviour change. Incorporating HCS training into midwifery education and continuing professional development would facilitate this. HCS is a scalable, brief intervention with the potential to improve the diets and physical activity levels of women during pregnancy, and hence the health of themselves and their babies.     

Gut microbial composition difference between pediatric ALL survivors and siblings

Abstract

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer with high cure rates leading to rising numbers of long-term survivors. Adult survivors of childhood ALL are at increased risk of obesity, cardiovascular disease, and other chronic illnesses. We hypothesize that ALL therapy is associated with long-term gut microbiome alterations that contribute to predisposition to chronic medical conditions. We conducted a pilot study to test whether differences can be detected between stool microbiota of pediatric ALL survivors and their siblings. Stool samples were collected from 38 individuals under age 19 who were at least 1?year after completion of therapy for ALL. Stool samples collected from 16 healthy siblings served as controls. 16S ribosomal RNA gene sequencing was performed on the stool samples. Comparing microbiota of survivors to sibling controls, no statistically significant differences were found in alpha or beta diversity. However, among the top 10 operational taxonomic units (OTUs) from component 1 in sparse partial least squares discriminant analysis (sPLS-DA) with different relative abundance in survivors versus siblings, OTUs mapping to the genus Faecalibacterium were depleted in survivors. Differences in gut microbial composition were found between pediatric survivors of childhood ALL and their siblings. Specifically, the protective Faecalibacterium is depleted in survivors, which is reminiscent of gut microbiota alteration found in adult survivors of childhood ALL and reported in obesity, suggesting that microbiota alterations in pediatric ALL survivors start in childhood and may play a role in predisposition to chronic illness in later years of survivorship.     

葛根水提取物对小鼠红细胞膜脂流动性和血常规的影响

目的研究葛根水提取物对小鼠红细胞膜脂流动性和血常规的影响。方法小鼠给予葛根水提取物(0.01、0.1、1g·ml-1)3个剂量,并设阴性、阳性对照组,连续给药20d,于停药次日眼球取血,用DPH荧光探针法测定红细胞膜脂流动性;用血细胞分析仪进行血常规检测。结果葛根水提取物0.1、1g·ml-1剂量组、阳性对照组与阴性对照组相比,红细胞膜脂流动性有显著增高(P<0.05),并显著降低微黏度(P<0.05)。血常规检测中葛根水提取物3个剂量组,阳性对照组与阴性对照组相比WBC、MCV、PLT有轻微下降的趋势,无显著影响(P>0.05)。结论葛根能明显升高红细胞膜脂流动性,降低微黏度,改善微循环,具有良好的活血化瘀作用。使用中注意其不良反应,定期检查血常规。     

Role of Routine Repeat Head CT for Pediatric Patients under 2 Years Old with Mild-to-moderate Traumatic Brain Injury

Repeat head computed tomography (RHCT) is common and routine for pediatric traumatic brain injury (TBI) patients. In mild (Glasgow Coma Scale; GCS 13–15) to moderate (GCS 9–12) TBI, recent studies have shown that RHCT without clinical deterioration does not alter management. However, the effectiveness of routine RHCT for pediatric TBI patients under 2 years has not been investigated. This study aims to investigate whether routine RHCT changes management in mild-to-moderate TBI patients under 2 years. We performed a retrospective review at the emergency department of the National Center for Child Health and Development between January 2015 and December 2019. Mild-to-moderate TBI patients under 2 years with an acute intracranial injury on initial head CT scan and receiving follow-up CT scans were included. Mechanism, severity of TBI, indication for RHCT, and their findings were listed. Study outcome was intervention based on the findings of RHCT. Intervention was defined as intubation, ICP monitor placement, or neurosurgery. We identified 50 patients who met inclusion criteria and most patients (48/50) had mild TBI. The most common mechanism was ‘fall’ (68%). Almost all RHCT was routine and the overall incidence of radiographic progression on RHCT was 12%. RHCT without clinical deterioration did not lead to intervention, although one patient with moderate TBI required intervention due to radiographic progression with clinical symptoms. Our study showed that routine RHCT without clinical deterioration for mild TBI patients under 2 years may not alter clinical management. We suggest that RHCT be considered when there is clinical deterioration such as decrease in GCS.     

新生儿换血前后实验室指标的变化趋势

目的 探讨换血疗法对新生儿内环境造成的影响,为安全换血提供指导.方法 选取我院2016年1月～2018年12月诊断为ABO或Rh血型系统溶血病、并行换血治疗的高胆红素血症新生儿40例,分析换血治疗对患儿血常规、生化及凝血功能的影响.结果 40例患儿换血前总胆红素、直接胆红素和间接胆红素水平分别为390.4±17.98μ...     

医务人员严重急性呼吸综合征患者检验随访分析

目的了解在严重急性呼吸综合征(SARS)流行期及恢复期，我院77例院内感染医务人员血样检测的监测情况。方法血常规采用5分类计数，淋巴细胞亚群用流式细胞仪法，20项生化标志使用全自动生化分析仪，抗SARS—IgG采用EIA法，对患者随访5次，在3个月时有120例正常人对照，统计使用方差分析。结果白细胞及淋巴细胞早期下降。淋巴细胞亚群在病后3个月大多恢复，虽有一定异常率，但无统计学意义。生化标志ALT、AST、LDH、γ—GT在发病早期均有明显升高，在3个月后复常并稳定。血糖早期升高，1．5个月恢复正常。抗SARS—IgG在追访的5个时段内平均3个月100％阳性至12个月仍稳定，对照组1．67％阳性。结论SARS患者的血细胞总数及淋巴细胞绝对计数在疾病早期有辅助诊断价值。患者病后3个月的NK—Lym(CD16^ CD56^ )、B—Lym(CD19^ )、T—Lym(CD3^ )、T—Lym(CD3^ CD4^ )、T—Lym(CD3^ CD8^ )均无统计学意义改变。疾病早期可能因治疗影响糖代谢，并有一定的肝损害。患者抗SARS—IgG在发病3个月时基本全部出现至12个月仍稳定。     

血常规参数在SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者中诊断与鉴别诊断的意义

目的了解新型冠状病毒(SARS-CoV-2)感染初期血常规特点,分析SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者血常规等指标,为早期临床诊断治疗提供依据。方法回顾性分析2019年11月至2020年2月该院发热门诊就诊患者,通过诊断标准将其分为SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者,对4组患者进行血常规筛查,选择有鉴别意义的标志物。结果该研究纳入发热门诊发热待查患者91例,其中SARS-CoV-2感染确诊患者9例,疑似患者31例,甲型流感患者31例,乙型流感患者20例。SARS-CoV-2感染确诊患者与另外3组相比,白细胞与血小板为有鉴别意义的生物标志物,与流感患者相比,淋巴细胞同样为有鉴别意义的生物标志物。结论血常规参数在SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者中诊断与鉴别诊断具有一定的意义,可以作为核酸检测的重要补充。     

Sleep characteristics of young children in Japan: Internet study and comparison with other Asian countries

Background: A recent international Internet‐based study of young children (birth to 36 months) found that total sleep duration in Japan was the shortest among 17 countries/regions. The present study compared features of children's sleep in Japan relative to those in other Asian countries/regions. Methods: Parents of 872 infants and toddlers in Japan (48.6% boys), and parents of 20 455 infants and toddlers in 11 other Asian countries/regions (48.1% boys; China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam) completed an Internet‐based expanded version of the Brief Infant Sleep Questionnaire. Results: Young children in Japan exhibited significantly fewer nocturnal wakings and shorter daytime sleep in comparison with other Asian countries/regions. Although the former finding was apparent in all age groups, the reduced duration of daytime sleep in Japan was not present until after 3 months of age. Interestingly, sleep problems were reported by significantly fewer parents in Japan compared with those in other Asian countries/regions, although parents in Japan reported significantly more difficulty at bedtime. Conclusions: The short sleep duration of young children in Japan is largely due to a relatively short duration of daytime sleep. Significant differences in sleep characteristics in Japan relative to other Asian regions were found primarily after 3 months of age. Future studies should further explore the underlying causes and the potential impacts of these sleep differences.     

补阳还五汤质量标准测定及对中风后遗症 "气虚血瘀"大鼠病证模型血常规的影响

目的：研究补阳还五汤水提物中黄芪甲苷、阿魏酸舍量的测定，作为该方的质量控制标准；复制中风后遗症“气虚血瘀”大鼠模型，观察补阳还五汤对其血常规的影响，从而探讨补阳还五汤在治疗中风后遗症方面的作用机制。方法：补阳还五汤采用传统煎法，黄芪甲苷采用高效液相色谱-蒸发光散射检测。阿魏酸采用高效液相色谱法。用仪器分析法检测血常规。结果：黄茂甲苷在0．24～6．00ug与峰面积积分值呈良好线性关系（r=0．9999），平均回收率100．79％。阿魏酸在0．08—0．24ug与峰面积积分值呈良好线性关系（r=0．9999），平均回收率101．76％。对血常规有影响，可降低白细胞，升高红细胞和血红蛋白，降低过多血小板数目。结论：补阳还五汤可提高免疫机能，改善气虚血瘀和能量代谢，改善循环功能，黄芪甲苷、阿魏酸的含量，可作为该方的质量控制标准。