To determine whether natural language processing (NLP) can effectively detect adverse events defined in the New York Patient Occurrence Reporting and Tracking System (NYPORTS) using discharge ...summaries.
An adverse event detection system for discharge summaries using the NLP system MedLEE was constructed to identify 45 NYPORTS event types. The system was first applied to a random sample of 1,000 manually reviewed charts. The system then processed all inpatient cases with electronic discharge summaries for two years. All system-identified events were reviewed, and performance was compared with traditional reporting.
System sensitivity, specificity, and predictive value, with manual review serving as the gold standard.
The system correctly identified 16 of 65 events in 1,000 charts. Of 57,452 total electronic discharge summaries, the system identified 1,590 events in 1,461 cases, and manual review verified 704 events in 652 cases, resulting in an overall sensitivity of 0.28 (95% confidence interval CI: 0.17–0.42), specificity of 0.985 (CI: 0.984–0.986), and positive predictive value of 0.45 (CI: 0.42–0.47) for detecting cases with events and an average specificity of 0.9996 (CI: 0.9996–0.9997) per event type. Traditional event reporting detected 322 events during the period (sensitivity 0.09), of which the system identified 110 as well as 594 additional events missed by traditional methods.
NLP is an effective technique for detecting a broad range of adverse events in text documents and outperformed traditional and previous automated adverse event detection methods.
Individual contributions of obesity and physical fitness (physical activity and functional capacity) to risk of coronary heart disease in women remain unclear.
To investigate the relationships of ...measures of obesity (body mass index BMI, waist circumference, waist-hip ratio, and waist-height ratio) and physical fitness (self-reported Duke Activity Status Index DASI and Postmenopausal Estrogen-Progestin Intervention questionnaire PEPI-Q scores) with coronary artery disease (CAD) risk factors, angiographic CAD, and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia.
The National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) is a multicenter prospective cohort study. From 1996-2000, 936 women were enrolled at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (mean follow-up, 3.9 SD, 1.8 years) for adverse outcomes.
Prevalence of obstructive CAD (any angiographic stenosis >or=50%) and incidence of adverse CV events (all-cause death or hospitalization for nonfatal myocardial infarction, stroke, congestive heart failure, unstable angina, or other vascular events) during follow-up.
Of 906 women (mean age, 58 SD, 12 years) with complete data, 19% were of nonwhite race, 76% were overweight (BMI >or=25), 70% had low functional capacity (DASI scores <25, equivalent to <or=7 metabolic equivalents METs), and 39% had obstructive CAD. During follow-up, 337 (38%) women had a first adverse event, 118 (13%) had a major adverse event, and 68 (8%) died. Overweight women were more likely than normal weight women to have CAD risk factors, but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors (P =.05 to.88). Conversely, women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD (44% vs 26%, P<.001) at baseline, and each 1-MET increase in DASI score was independently associated with an 8% (hazard ratio, 0.92; 95% confidence interval, 0.85-0.99; P =.02) decrease in risk of major adverse CV events during follow-up.
Among women undergoing coronary angiography for suspected ischemia, higher self-reported physical fitness scores were independently associated with fewer CAD risk factors, less angiographic CAD, and lower risk for adverse CV events. Measures of obesity were not independently associated with these outcomes.
Evidence suggests that early adverse experiences play a preeminent role in development of mood and anxiety disorders and that corticotropin-releasing factor (CRF) systems may mediate this ...association.
To determine whether early-life stress results in a persistent sensitization of the hypothalamic-pituitary-adrenal axis to mild stress in adulthood, thereby contributing to vulnerability to psychopathological conditions.
Prospective controlled study conducted from May 1997 to July 1999 at the General Clinical Research Center of Emory University Hospital, Atlanta, Ga.
Forty-nine healthy women aged 18 to 45 years with regular menses, with no history of mania or psychosis, with no active substance abuse or eating disorder within 6 months, and who were free of hormonal and psychotropic medications were recruited into 4 study groups (n = 12 with no history of childhood abuse or psychiatric disorder controls; n = 13 with diagnosis of current major depression who were sexually or physically abused as children; n = 14 without current major depression who were sexually or physically abused as children; and n = 10 with diagnosis of current major depression and no history of childhood abuse).
Adrenocorticotropic hormone (ACTH) and cortisol levels and heart rate responses to a standardized psychosocial laboratory stressor compared among the 4 study groups.
Women with a history of childhood abuse exhibited increased pituitary-adrenal and autonomic responses to stress compared with controls. This effect was particularly robust in women with current symptoms of depression and anxiety. Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls (net peak of 9.0 pmol/L 41.0 pg/mL; 95% confidence interval CI, 4.7-13.3 pmol/L 21.6-60. 4 pg/mL; vs net peak of 1.4 pmol/L 6.19 pg/mL; 95% CI, 0.2-2.5 pmol/L 1.0-11.4 pg/mL; difference, 8.6 pmol/L 38.9 pg/mL; 95% CI, 4.6-12.6 pmol/L 20.8-57.1 pg/mL; P<.001).
Our findings suggest that hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse that may contribute to the diathesis for adulthood psychopathological conditions. Furthermore, these results imply a role for CRF receptor antagonists in the prevention and treatment of psychopathological conditions related to early-life stress. JAMA. 2000;284:592-597
To determine whether Salmonella spp could be isolated from the environment of free stall dairies in Wisconsin without any history of clinical salmonellosis and determine the serotype and ...antimicrobial susceptibility of any Salmonella isolates recovered from the environment.
Cross-sectional study.
20 free stall dairies with no history of clinical salmonellosis.
Dairy owners completed a questionnaire regarding management and production practices. Multiple swab samples were obtained from throughout the free stall facilities and submitted for bacterial culture for Salmonella spp. Odds ratios were calculated to compare herd-level risk factors between dairies from which Salmonella organisms were isolated and herds from which Salmonella organisms were not isolated.
Salmonella organisms were isolated from 9 of the 20 (45%) dairies. Salmonella serotype Meleagridis was isolated from 4 dairies, S. Meleagridis and S. Kentucky were isolated from 2 dairies, S. Meleagridis and S. Cyprus were isolated from 1 dairy, S. Cerro was isolated from 1 dairy, and S. Corvallis was isolated from 1 dairy. All isolates were susceptible to all antimicrobial agents tested. None of the potential risk factors analyzed demonstrated a significant association with an increased likelihood of isolating Salmonella spp.
Environmental Salmonella contamination was demonstrated on free stall dairies with no history of clinical salmonellosis.
Objective—To determine the incidence of adverse events in ferrets vaccinated with a modified-live avian cell culture canine distemper virus vaccine licensed for use in ferrets, an inactivated rabies ...vaccine licensed for use in ferrets, or both. Design—Retrospective study.Animals—143 ferrets. Procedure—Medical records were reviewed to identify ferrets that had an adverse event after vaccination. Results—Adverse events developed within 25 minutes after vaccination in 13 ferrets. One ferret developed an adverse event after receiving a distemper and a rabies vaccine simultaneously and developed a second adverse event the following year after receiving the rabies vaccine alone. Therefore, a total of 14 adverse events were identified. All adverse events were an anaphylactic reaction characterized by generalized hyperemia, hypersalivation, and vomiting. Ten of the 14 anaphylactic reactions occurred after ferrets received both vaccines, 3 occurred after ferrets received the distemper vaccine alone, and 1 occurred after a ferret received the rabies vaccine alone. Incidences of adverse events after administration of both vaccines, the distemper vaccine alone, and the rabies vaccine alone were 5.6, 5.9, and 5.6%, respectively. Ferrets that had an anaphylactic reaction were significantly older at the time of vaccination than were ferrets that did not. Conclusions and Clinical Relevance—Results suggest that there may be a high incidence of anaphylactic reactions after vaccination of domestic ferrets. Ferrets should be observed for at least 25 minutes after vaccination, and veterinarians who vaccinate ferrets should be prepared to treat anaphylactic reactions.
To determine whether cytologic examination of exfoliative specimens obtained during endoscopy was as useful as histologic examination of mucosal biopsy specimens for the diagnosis of gastrointestinal ...tract disease in dogs and cats and to compare the diagnostic accuracy of 2 techniques (brush or touch) in preparing specimens for cytologic examination.
Prospective case series.
85 dogs and 23 cats.
Specimens for cytologic and histologic examination were obtained during routine endoscopic examination of the stomach, small intestine, and colon. A diagnosis was made on the basis of cytologic findings (graded objectively) and compared with the diagnosis on the basis of histologic findings.
The diagnostic accuracy of cytologic examination was high for all 3 organs. Sensitivities, specificities, and predictive values of positive and negative results were > 90% in most instances. The diagnostic accuracy of the brush technique was equal or superior to that of the touch technique for 84% of specimens. The brush technique was most useful in detecting cellular infiltrates in the lamina propria, whereas the touch technique was more likely to detect acute mucosal inflammation. Percentages of false-positive (3.2%) and false-negative (6.9%) cytologic interpretations were low.
Endoscopy is safe and requires little time to procure specimens for cytologic examination, which can be obtained concurrently with mucosal biopsy specimens. Cytologic examination of exfoliative specimens obtained during endoscopy is a useful and reliable adjunct to histologic examination of biopsy specimens in the diagnosis of gastrointestinal tract disease in dogs and cats.
To determine whether intracameral injection of carbachol at the completion of phacoemulsification in dogs would prevent the increase in intraocular pressure (i.o.p) that can develop during the first ...24 hours after surgery.
Randomized controlled trial.
32 adult dogs undergoing elective unilateral or bilateral phacoemulsification.
Dogs were randomly assigned to 1 of 4 groups with 8 dogs/group: phacoemulsification and intracameral administration of 0.5 ml of 0.01% carbachol at the end of surgery; phacoemulsification, intraocular lens implantation, and intracameral administration of 0.5 ml of 0.01% carbachol; phacoemulsification and intracameral administration of 0.5 ml of balanced salt solution; and phacoemulsification, intraocular lens implantation, and intracameral administration of 0.5 ml of balanced salt solution. Intraocular pressure was measured at 3 and 6 hours and the morning after surgery. Aqueous flare was also measured 6 hours and the morning after surgery.
None of the dogs treated with carbachol developed postoperative ocular hypertension (i.e., IOP > 27 mm of Hg), whereas 12 of 16 control dogs had ocular hypertension 3 hours after surgery. Intraocular pressure 3 hours after surgery was not significantly associated with phacoemulsification time or phacoemulsification power or with whether the dog received an intraocular lens implant. Severity of aqueous flare was similar for treated and control dogs.
Results suggested that intracameral administration of 0.01% carbachol at the end of surgery was a safe and efficacious method of preventing the postoperative increase in IOP associated with phacoemulsification in dogs.
To determine clinical signs and clinicopathologic abnormalities in Greyhounds with cutaneous and renal glomerular vasculopathy and to determine whether there were any differences between dogs with ...and without renal azotemia.
Retrospective study.
18 Greyhounds.
Results of CBC, serum biochemical analyses, urinalyses, coagulation tests, tests of RBC morphology, bacterial culture of blood samples, and serologic tests for Rickettsia rickettsii, Ehrlichia canis, E platys, and Leptospira interrogans were reviewed. Glomerular filtration rates and urine protein:creatinine ratios were determined in most dogs. t-Tests and a test of equality of proportions were used to compare dogs that developed renal azotemia with dogs that did not.
None of the dogs was bacteremic or had serologic evidence of infectious disease. Ten dogs had renal azotemia, 16 had anemia, 11 had hypoalbuminemia, and 18 developed thrombocytopenia. Compared with dogs without renal azotemia, dogs with renal azotemia had significantly lower mean platelet count, hematocrit, and serum albumin concentration and significantly higher mean neutrophil count and creatine kinase activity. All 10 dogs with renal azotemia died or were euthanatized; 7 of 8 dogs without azotemia survived.
Greyhounds with cutaneous and renal glomerular vasculopathy that developed renal azotemia had evidence of more severe systemic disease than did dogs that did not have azotemia and, despite supportive treatment, had a poorer prognosis.
Patients' stories as narrative Henderson, C Brooks
JAMA : the journal of the American Medical Association,
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