scholarly journals P.045 Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Testing in Calgary: A Quality Improvement Review

2021 ◽  
Vol 48 (s3) ◽  
pp. S32-S32
Author(s):  
JD Krett ◽  
H Hou ◽  
K Alikhani ◽  
MJ Fritzler ◽  
JM Burton
Keyword(s):  
Quality Improvement ◽  
Mayo Clinic ◽  
Chart Review ◽  
False Negative ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Antibody Testing ◽  
Improvement Project ◽  
Confirmatory Testing ◽  
Mog Antibodies

Background: Despite the availability of cell-based assays for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies provincially, outside confirmatory testing is often performed (typically Mayo Clinic Laboratories, USA) when results deviate from expected. It is unknown how often this costly undertaking (upwards of $1,200 CAN) alters diagnosis and management. Methods: We undertook a quality improvement project evaluating the concordance/discordance rate with select chart review in all patients who had cell-based AQP4 or MOG IgG antibody testing at Mitogen Diagnostics (MitogenDx; Calgary, Alberta) and subsequent testing at Mayo Clinic Laboratories from as early as 2010 to July 2020. Results: Preliminary review of data from January 2016 to July 2020 retrieved 145 paired tests; 10 of which were discordant (concordance rate: 93.1%). Chart review confirmed 9 truly discordant cases, often associated with AQP4 or MOG weak-positive results (7/9 cases) or presumed false negative AQP4 results in prototypical neuromyelitis optica spectrum disorder (2/9 cases). Conclusions: Discordant results were rare when comparing MitogenDx local AQP4/MOG antibody test results to those referred out to Mayo Clinic Laboratories, impacting diagnosis and treatment in only 3 patients out of the total. Our results suggest costly outside confirmatory testing of AQP4/MOG antibodies could be reduced.

A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital

2021 ◽  
pp. 084456212110477
Author(s):  
Jodi Wilding ◽  
Hailey Scott ◽  
Victoria Suwalska ◽  
Zarina Geddes ◽  
Carolina Lavin Venegas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Chart Review ◽  
Management Practices ◽  
Pain Treatment ◽  
Management Strategies ◽  
Improvement Project ◽  
Pain Scores ◽  
Health Quality ◽  
T1 And T2

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. Methods Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) – post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. Results At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. Conclusion No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.

scholarly journals Aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies in immune-mediated optic neuritis at long-term follow-up

2019 ◽  
Vol 90 (9) ◽  
pp. 1021-1026 ◽  
Author(s):  
Axel Petzold ◽  
Mark Woodhall ◽  
Z Khaleeli ◽  
W Oliver Tobin ◽  
Sean J Pittock ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Serum Levels ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Oligoclonal Bands ◽  
Antibody Testing ◽  
Serum Samples ◽  
Original Cohort ◽  
Number Of Patients ◽  
The Impact

ObjectivesTo re-evaluate serum samples from our 2007 cohort of patients with single-episode isolated ON (SION), recurrent isolated ON (RION), chronic relapsing inflammatory optic neuropathy (CRION), multiple sclerosis-associated ON (MSON) and neuromyelitis optica (NMO).MethodsWe re-screened 103/114 patients with available serum on live cell-based assays (CBA) for aquaporin-4 (AQP4)-M23-IgG and myelin-oligodendrocyte glycoprotein (MOG)-α1-IgG. Further testing included oligoclonal bands, serum levels of glial fibrillar acidic and neurofilament proteins and S100B. We show the impact of updated serology on these patients.ResultsReanalysis of our original cohort revealed that AQP4-IgG seropositivity increased from 56% to 75% for NMO, 5% to 22% for CRION, 6% to 7% for RION, 0% to 7% for MSON and 5% to 6% for SION. MOG-IgG1 was identified in 25% of RION, 25% of CRION, 10% of SION, 0% of MSON and 0% of NMO. As a result, patients have been reclassified incorporating their autoantibody status. Presenting visual acuity was significantly worse in patients who were AQP4-IgG seropositive (p=0.034), but there was no relationship between antibody seropositivity and either ON relapse rate or visual acuity outcome.ConclusionsThe number of patients with seronegative CRION and RION has decreased due to improved detection of autoantibodies over the past decade. It remains essential that the clinical phenotype guides both antibody testing and clinical management. Careful monitoring of the disease course is key when considering whether to treat with prophylactic immune suppression.

scholarly journals A Quality Improvement Project to Minimize COVID-19 Infections in Patients Receiving Haemodialysis and the Role of Routine Surveillance Using Nose and Throat Swabs for SARS-CoV-2 rRT-PCR and Serum Antibody Testing

Nephron ◽  
2021 ◽  
pp. 1-8
Author(s):  
Dimitrios Poulikakos ◽  
Rajkumar Chinnadurai ◽  
Yvonne Mcgee ◽  
Simon Gray ◽  
Toni Clough ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibody Response ◽  
Serum Antibody ◽  
Antibody Testing ◽  
Improvement Project ◽  
Pcr Screening ◽  
Routine Surveillance ◽  
Before And After ◽  
Asymptomatic Phase ◽  
Pcr Test

<b><i>Background:</i></b> Patients receiving in-centre haemodialysis (ICHD) are highly vulnerable to COVID-19. <b><i>Objective:</i></b> We created a quality improvement (QI) project aimed to eliminate outbreaks of COVID-19 in haemodialysis units and evaluated the utility of surveillance rRT-PCR test and SARS-CoV-2 serum antibodies for prompt identification of patients infected with COVID-19. <b><i>Methods:</i></b> A multifaceted QI programme including a bundle of infection prevention control (IPC) measures was implemented across 5 ICHD units following the first wave of the pandemic in June 2020. Primary outcomes evaluated before and after QI implementation were incidence of outbreaks and severe COVID-19 illness defined as COVID-19-related death or hospitalization. Secondary outcomes included the proportion of patients identified in the pre-symptomatic/asymptomatic phase on surveillance rRT-PCR screening and the incidence and longevity of SARS-CoV-2 antibody response. <b><i>Results:</i></b> Following the implementation of the QI project, there were no further outbreaks. Pre- and post-implementation comparison showed a significant reduction in COVID-19-related mortality and hospitalization (26 vs. 13 events, respectively, <i>p</i> &#x3c; 0.001). Surveillance rRT-PCR screening identified 39 asymptomatic or pre-symptomatic cases out of a total of 59 rRT-PCR-positive patients (39/59, 66%). SARS-CoV-2 antibody levels were detected in 72/74 (97%) rRT-PCR-positive patients. Amongst rRT-PCR-positive patients diagnosed before August 2020, 96% had detectable antibodies until January 2021 (days from the rRT-PCR test to last antibody testing, 245–280). <b><i>Conclusions:</i></b> Systematic implementation of a bundle of IPC measures using QI methodology and surveillance rRT-PCR eliminated outbreaks in HD facilities. Most HD patients mount and sustain antibody response to COVID-19 for over 8 months.

Neuromyelitis Optica Spectrum Disorder and Anti-Aquaporin 4 Channel Immunoglobulin in an Australian Pediatric Demyelination Cohort

2020 ◽  
Vol 35 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Ariel Dahan ◽  
Fabienne Brilot ◽  
Richard Leventer ◽  
Andrew J. Kornberg ◽  
Russell C. Dale ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Neuromyelitis Optica ◽  
Immunoglobulin G ◽  
Axonal Neuropathy ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Spectrum Disorder ◽  
Aquaporin 4 ◽  
Disease Course ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Mog Antibodies

Neuromyelitis optica spectrum disorder is uncommon in children, and often seronegative for aquaporin-4 immunoglobulin G (AQP4-IgG). We conducted a retrospective study of 67 children presenting to a single Australian center with acquired demyelinating syndromes over a 7-year period. All patients were tested for AQP4-IgG. Five children (7.5%) had neuromyelitis optica spectrum disorder. One child was seropositive for AQP4-IgG (1.5%) and had a relapsing disease course with mild residual deficits. She also had a concomitant motor axonal neuropathy that improved with immunosuppressive therapy. Of the remaining 4 children, 3 had a monophasic course and 1 a relapsing course. Two were tested for anti–myelin oligodendrocyte glycoprotein (anti-MOG) antibody and both were seropositive. This study confirms that neuromyelitis optica spectrum disorder is uncommon in children, and that AQP4-IgG seropositivity is rare. Anti-MOG antibodies should be tested in children with neuromyelitis optica spectrum disorder.

LO013: Can you trust administrative data? Accuracy of ICD-10 codes for diagnosis of pulmonary embolism

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S34-S34
Author(s):  
K. Burles ◽  
D. Wang ◽  
D. Grigat ◽  
K.D. Senior ◽  
G. Innes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Quality Improvement ◽  
Administrative Data ◽  
Chart Review ◽  
Research Quality ◽  
Administrative Database ◽  
Discharge Diagnosis ◽  
Improvement Project ◽  
Icd 10 ◽  
Hospital Administrative

Introduction: Administrative data is a useful tool for research and quality improvement; however, the validity of research findings based on these data depends on their reliability. Diagnoses are recorded using diagnostic codes, as defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Several groups have reported coding errors associated with ICD-10 assignments to patient diagnoses; these errors have serious implications for research, quality improvement, and policymaking. As part of a quality improvement project targeting emergency department (ED) diagnostic appropriateness for pulmonary embolism (PE), we sought to validate the accuracy of ICD-10 codes for studying ED patients diagnosed with PE. Methods: Hospital administrative data for adult patients (age ≥18 years) with an ICD-10 code for PE (I26.0 and I26.9) were obtained from the records of four urban EDs between July 2013 to January 2015. A review of medical records and imaging reports was used to confirm the diagnosis of PE. In the case of discrepancy between ICD-10 coding and chart review, the diagnosis obtained from chart review was considered correct. The physicians’ discharge notes in the administrative database were also searched using ‘pulmonary embolism’ and ‘PE’, and patients who were diagnosed with PE but not coded as PE were identified. Coding discrepancies were quantified and described. Results: 1,453 ED patients had a PE ICD-10 code during our study period. 257 (17.7%) of these patients’ diagnoses were improperly coded. 211 patients assigned an ICD-10 PE code had ED discharge diagnoses of ‘rule-out PE’ or ‘query PE’. 64 other patients were miscoded as having a PE and should have been assigned an alternate code, such as chest pain, hypoxia, or dyspnea. The physician did not include a discharge diagnosis in 4 of the 64 miscoded patients; however, triage and physician assessment notes indicated no suspicion of PE. Furthermore, 117 patients who had an ED discharge diagnosis of PE were not assigned a PE code, meaning that 8.91% of true PEs were missed by using ICD-10 codes alone. Thus, 1,313 ED patients truly had a PE. Conclusion: Our work suggests the need for more accuracy in ICD-10 coding of ED diagnoses of PE. Caution should be exercised when using administrative data for studying PE, and validation of the accuracy of ICD-10 coding prior to research use is recommended.

An e-Chart Review of Chaplains’ Interventions and Outcomes: A Quality Improvement and Documentation Practice Enhancement Project

2017 ◽  
Vol 71 (3) ◽  
pp. 183-191 ◽  
Author(s):  
Vivian B. Stang
Keyword(s):  
Quality Improvement ◽  
Spiritual Care ◽  
Chart Review ◽  
Patient Centered ◽  
Improvement Project ◽  
Quality Improvement Process ◽  
Ottawa Hospital ◽  
Reporting Requirements ◽  
Centered Care ◽  
The Impact

In Canada, the spiritual care landscape in health care settings is becoming more regulated and standardized documentation is part of this rigorous environment. Staff chaplains at The Ottawa Hospital participated in a Quality Improvement project that aimed to advance patient-centered care through better charting practices. A sample of 104 spiritual-care assessments that had been posted on the patient electronic health record was examined. This chart review focused on chaplains’ activities that were reported as interventions as well as chaplain-reported outcomes for the patient. These interventions and outcomes were coded into discreet categories in order to get a better sense of the activities and the impact of their work. The chaplains’ electronic charting content and practices were evaluated. Chaplains found that the Quality Improvement process was beneficial as they updated their electronic templates in order to meet the new reporting requirements of the College of Registered Psychotherapists of Ontario.

scholarly journals CNS Demyelinating Attacks Requiring Ventilatory Support With Myelin Oligodendrocyte Glycoprotein or Aquaporin-4 Antibodies

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012599
Author(s):  
Hannah H. Zhao-Fleming ◽  
Cristina Valencia Sanchez ◽  
Elia Sechi ◽  
Jery Inbarasu ◽  
Eelco F. Wijdicks ◽  
...  
Keyword(s):  
Mayo Clinic ◽  
Ventilatory Support ◽  
Acute Disseminated Encephalomyelitis ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Respiratory Support ◽  
Mri Findings ◽  
Black Race ◽  
Non Invasive ◽  
Aqp4 Antibody

Background and Objective:Severe attacks of myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disorder (MOGAD) and aquaporin-4 (AQP4)-antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) may require ventilatory support but data on episodes is limited, particularly for MOGAD. We sought to compare the frequency, characteristics, and outcomes of MOGAD and AQP4-NMOSD attacks requiring ventilatory support.Methods:This retrospective descriptive study identified Mayo Clinic patients (1/1/1996-12/1/2020) with MOGAD or AQP4-NMOSD and an attack requiring non-invasive or invasive ventilation at Mayo Clinic or an outside facility by searching for relevant terms in their electronic medical record. Inclusion criteria were: 1) Attack-related requirement for non-invasive (BiPAP or CPAP) or invasive respiratory support (mechanical ventilation); 2) MOG or AQP4 antibody positivity with fulfillment of MOGAD and AQP4-NMOSD clinical diagnostic criteria, respectively; 3) Sufficient clinical details. We collected data on demographics, co-morbidities, indication for and duration of respiratory support, MRI findings, treatments, and outcomes. The race of those with attacks requiring respiratory support were compared to those without such attacks in MOGAD and AQP4-NMOSD.Results:Attacks requiring ventilatory support were similarly rare in MOGAD (8/279, 2.9%) and AQP4-NMOSD patients (11/503, 2.2%) (p=0.63). The age at attack (median years [range]) (MOGAD, 31.5[5-47] vs AQP4-NMOSD, 43[14-65]; p=0.01) and percentage of female sex (MOGAD, 3/8[38%] vs AQP4-NMOSD, 10/11[91%]; p=0.04) differed. The reasons for ventilation differed between MOGAD (inability to protect airway from seizure, encephalitis or encephalomyelitis with attacks of: acute disseminated encephalomyelitis, 5[62.5%]; or unilateral cortical encephalitis, 3[37.5%]) and AQP4-NMOSD (inability to protect airway from cervical myelitis, 9[82%]; rhombencephalitis, 1[9%]; or combinations of both, 1[9%]). Median ventilation duration for MOGAD was 2 days (range, 1-7) versus 19 days (range, 6-330) for AQP4-NMOSD (p=0.01). All MOGAD patients recovered, but 2/11 (18%) of AQP4-NMOSD died from the attack. For AQP4-NMOSD, Black race was over-represented with attacks requiring ventilatory support versus those without these episodes (5/11[45%] versus 88/457[19%]; p=0.045).Discussion:Ventilatory support is rarely required for MOGAD and AQP4-NMOSD attacks and the indications differ. When compared to MOGAD, these attacks in AQP4-NMOSD may have higher morbidity and mortality and those of Black race were more predisposed, which we suspect may relate to socially mediated health inequality.

Comparison of MOG and AQP4 antibody seroprevalence in Korean adults with inflammatory demyelinating CNS diseases

2020 ◽  
pp. 135245852094821
Author(s):  
Jae-Won Hyun ◽  
Hye Lim Lee ◽  
Woo Kyo Jeong ◽  
Hye Jung Lee ◽  
Jong Hwa Shin ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Demyelinating Diseases ◽  
Aquaporin 4 ◽  
Cns Diseases ◽  
Korean Adults ◽  
The Central Nervous System ◽  
Mog Antibodies ◽  
Aqp4 Antibody

We aimed to compare seroprevalence of anti-myelin oligodendrocyte glycoprotein (MOG) and anti-aquaporin-4 (AQP4) antibodies in Korean adults with inflammatory demyelinating diseases (IDDs) of the central nervous system (CNS), based on a multicenter nationwide database. Sera were analyzed using a live cell–based assay for MOG and AQP4 antibodies. Of 586 Korean adults with IDDs of the CNS, 36 (6.1%) and 185 (31.6%) tested positive for MOG and AQP4 antibodies, respectively. No participant showed double positivity. Seroprevalence of MOG antibodies was about five times lower than that of AQP4 antibodies in a large cohort of Korean adults with IDDs of the CNS.

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