Editor’s Foreword

2016 ◽  
pp. 189-192
Author(s):  
Ishak Ramzy
Keyword(s):  
Clinical Notes ◽  
History Of

The editor of The Piggle, Ishak Ramzy, describes his experience of meeting and working with Winnicott, and describes the history of the clinical notes on the Piggle.

P647An audit of possible familial hypercholesterolaemia in general practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Gallagher ◽  
M McGuckin ◽  
D Behan ◽  
P Harrington
Keyword(s):  
Cardiovascular Disease ◽  
General Practice ◽  
Familial Hypercholesterolaemia ◽  
Lipid Lowering ◽  
Inclusion Criteria ◽  
Clinical Notes ◽  
Structured Care ◽  
Premature Cardiovascular Disease ◽  
History Of ◽  
The Mean

Abstract Background Familial hypercholesterolaemia (FH) is an autosomal dominant condition associated with elevated total cholesterol and low-density lipoprotein (LDL). It confers an increased risk of premature cardiovascular disease and associated mortality. It is estimated that the majority of patients with FH in Ireland are undiagnosed and structured care programmes are not available. Purpose To undertake an audit of those patients in a general practice with possible FH Methods A retrospective audit was carried out on the patients attending a GP practice. Inclusion criteria for the study were as follows: LDL level >4.9mmol/L Triglyceride level (<2mmol/L) Data was collected from the patients' clinical notes and patients were interviewed to acquire additional details not available in the clinical notes where possible. A Dutch Lipid Clinic Network Score (DLCNS) was calculated for each patient. Results Of 5,438 patients with a LDL recorded 284 patients fulfilled the inclusion criteria. 52.4% were female. Mean age 60 years old (range: 19–95 years). The highest LDL level recorded for these patients ranged from 5.0 - 8.6 mmol/L, with a mean value of 5.4 mmol/L. The mean most recent LDL level was 3.6mmol/L (range: 1.0–6.3 mmol/L). 42 patients (14.8%) had a family history of premature coronary and/or vascular disease in line with DLCNS criteria. 9 patients (3.2%) had a personal history of premature cardiovascular disease. The DLCNS was calculated for each patient based on the information available. 225 patients (79.2%) had a score of 3, 36 patients (12.7%) had a score of 4, 12 patients (4.2%) had a score of 5 and 6 patients (2.1%) had a score of 6. This equates to 273 patients (96.1%) with a possible diagnosis of FH, and 6 patients (2.1%) with a probable diagnosis of FH. The mean most recent systolic blood pressure reading for these patients was 128mmHg, and diastolic 76mmHg. 51 patients (18%) were current smokers, 83 (29.2%) were ex-smokers, and 111 (39%) had never smoked. Smoking status was unknown for 38 patients (13.4). 128 patients (45%) were on lipid-lowering treatment at the time of this audit. 60 (21.1%) were on high intensity treatment, 68 (23.9%) were on medium intensity treatment and none were on low intensity treatment. 24.3% of patients were at target LDL. There were 5 patients (1.8%) currently receiving ezetimibe and 1 (0.4%) on fenofibrate. Conclusion A significant number of patients had a LDL >5mmol/l in this audit. Only 45% were on lipid lowering treatment and 24.3% were at a target LDL. This highlights the needs for structured programmes for screening and management of FH in primary care. Acknowledgement/Funding Funded by an unrestricted grant from Amgen

A computerized algorithm to capture patient’s past preeclampsia and eclampsia history from prenatal clinical notes

2018 ◽  
Vol 25 (4) ◽  
pp. 1299-1313 ◽  
Author(s):  
Fagen Xie ◽  
Theresa Im ◽  
Darios Getahun
Keyword(s):  
Electronic Medical Records ◽  
Predictive Value ◽  
Medical Records ◽  
Past History ◽  
Rule Based ◽  
High Performing ◽  
Clinical Notes ◽  
Sentence Level ◽  
Risk Patients ◽  
History Of

Prenatal clinical notes in electronic medical records contain a wealth of information on pregnancy complications and outcomes. Extracting this critical information provides a unique opportunity for risk assessment to identify at-risk patients who may benefit from early monitoring and intervention. We developed and validated a rule-based computerized algorithm called PregHisEx to characterize past obstetrical history (preeclampsia/eclampsia) by mining prenatal clinical notes for women delivered in 2012 within a large healthcare maintenance organization. The algorithm successfully identified cases with past history of preeclampsia/eclampsia: 2984 definite and 479 probable cases at sentence level; 2419 definite and 348 probable cases at note level; and 762 definite and 82 probable cases at pregnancy episode level. Validation conducted on a random sample of 200 notes using PregHisEx yielded 88.0 percent sensitivity, 98.9 percent specificity, 91.7 percent positive predictive value, 98.3 percent negative predictive value, and F-score of 0.90. The high-performing PregHisEx can be applied for other prenatal conditions.

History-Taking

2016 ◽  
pp. 173-186
Author(s):  
Donald W. Winnicott
Keyword(s):  
Family History ◽  
Past History ◽  
History Taking ◽  
Clinical Notes ◽  
The Past ◽  
The Family ◽  
History Of

Chapter 1 of Clinical Notes on Disorders of Childhood. In this chapter, Winnicott argues for the importance of history taking in child medicine: the past history of the child, the family history, and the history of onset of the illness. He gives several cases which illustrate the value to the physician of taking the time to hear a full history.

Using natural language processing (NLP) tools to identify veterans with metastatic prostate cancer (mPCa).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 60-60
Author(s):  
Patrick R. Alba ◽  
Julie Ann Lynch ◽  
Anthony Gao ◽  
Kyung Min Lee ◽  
Tori Anglin-Foote ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Language Processing ◽  
Veterans Affairs ◽  
Disease State ◽  
Risk Status ◽  
Clinical Notes ◽  
Age Of Diagnosis ◽  
History Of ◽  
Development And Validation ◽  
Treatment Table

60 Background: Veterans may benefit from promising innovations in treatments for mPCa. The Veterans Affairs (VA) and Prostate Cancer Foundation (PCF) leadership issued a challenge to identify, in real time, the national census of Veterans receiving care for mPCa. Administrative diagnostic and procedural coding do not accurately identify the risk status or disease state of prostate cancer (PCa). This study reports the development and validation of NLP tools deployed on clinical notes to identify risk status or disease state. Methods: Using diagnosis and histology codes, we queried the VA Corporate Data Warehouse to identify Veterans with prostate cancer. We included structured laboratory tests, medications, procedures, and surgeries related to prostate cancer diagnosis or treatment in the analysis. Using structured data, we identified 1000 likely mPCa cases and controls. Medical records were reviewed to confirm status and to extract term dictionaries related to cancer, anatomy, metastasis, and other diagnostic concepts. We went through several iterations of testing to refine and validate the NLP tool on a limited set of known cases and controls. We deployed the tool on all cancer, urology, pathology, and radiation oncology notes. Results: The NLP system was able to identify the patients' history of metastatic disease with 0.975 precision and 0.828 recall. Among the 1,081,137 Veterans with prostate cancer, NLP identified 63,222 (5.8%) with mPCa. There are 16,282 Veterans alive with mPCa. Mean age of diagnosis was 67 and 8,847 (54.3%) were diagnosed in the VA. Demographics were: White 9,756 (60%), Black 4,466 (27%), and other 2,060 (13%). Conclusions: NLP is a reliable tool for identifying Veterans who may benefit from novel innovations in mPCa diagnosis and treatment.[Table: see text]

913 An Audit of Colonoscopy Compliance Within A Screening Programme for Patients with A Family History of Colorectal Cancer (CRC)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Abbakar ◽  
P Boxall ◽  
T James ◽  
M Lim
Keyword(s):  
Family History ◽  
Lynch Syndrome ◽  
Screening Programme ◽  
Electronic Records ◽  
Risk Category ◽  
Surveillance Programme ◽  
Clinical Notes ◽  
History Of ◽  
Colonoscopy Surveillance ◽  
Risk Categories

Abstract Introduction Guidelines on the management of hereditary CRC were updated in 2019 and have led to more stringent use of surveillance colonoscopies. Patients with ‘family history’ (FH) CRC Surveillance programme at York Hospitals Trust were studied to assess compliance with colonoscopy recommendations. Method Current BSG/ACPGBI guidelines recommend biennial, quinquennial, one-off or no colonoscopy surveillance for patients with Lynch syndrome, and those deemed to have high, moderate, and average risks of developing hereditary cancer, respectively. Examination of electronic records and clinical notes were performed to determine if they were Lynch positive and/or if they could be assigned a risk category. Results Database of 227 patients, of which 14 were high, 61 moderate and 45 were low risk. 47 had Lynch syndrome. Compliance of colonoscopy was poor for patients with average and moderate FH risk (both 0%). Compliance was higher for patients with high risk of FH (50%) and those with Lynch syndrome (57%) Risk was indeterminate in 24 patients due to inadequate data therefore compliance could not be assessed. Conclusions A large proportion of patients with low to moderate ‘FH’ risk within our current surveillance programme had unnecessary colonoscopies. Stratification of patients into the appropriate risk categories optimizes the benefit from surveillance programmes.

scholarly journals Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Tatsuya Oishi ◽  
Cory J Kogelschatz ◽  
Nathan P Young ◽  
Ernest M Hoffmann ◽  
Nathan P Staff ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Neurological Complications ◽  
Secondary Malignancy ◽  
Spinal Meningioma ◽  
Major Morbidity ◽  
Clinical Notes ◽  
Outpatient Visits ◽  
History Of ◽  
Post Radiation ◽  
Neuromuscular Complications

Abstract Our study aims to quantitate neuromuscular morbidity from radiotherapy in Hodgkin lymphoma including: (i) frequency and (ii) time of onsets for neurological localizations; (iii) degree of disabilities and (iv) number of clinical visits compared to cardiopulmonary Hodgkin lymphoma-radiation complications. Medical records from Mayo Health systems were retrieved; identifying neuromuscular radiation treated Hodgkin lymphoma-complications from 1 January 1994 to 31 December 2016. Of an estimated 4100 post-radiotherapy Hodgkin lymphoma patients, 4.6% (189) were identified with complications. Mean latency to physician visit for symptoms was 23.7 years (range: 1–50). Most commonly identified complications included: head drop 10% (19) with or without myopathy, myopathy 39% (73), plexopathy 29% (54), myelopathy 27% (51) and polyradiculopathy 13% (24). Other findings included benign and malignant nerve sheath tumours 5% (9), phrenic and long thoracic mononeuropathies 7% (14) and compressive spinal meningioma 2% (4). Patients frequently had multiple coexisting complications (single = 76% [144], double = 17% [33], triple = 4% [8], quadruple = 2% [4]). Cardiac 28% (53) and pulmonary 15% (29) complications were also seen in these patients. History of Hodgkin lymphoma was initially overlooked by neurologists (14.3%, 48/336 clinical notes). Hospital and outpatient visits for complications were frequent: neuromuscular 19% (77/411) versus cardiopulmonary 30% (125/411). Testing was largely exclusionary, except when imaging identified secondary malignancy. Modified Rankin score at diagnosis varied: 0–1 (55.8%), 2–3 (5.8%) and 4–5 (38.3%). Neuromuscular complications among post-radiation Hodgkin lymphoma are diverse, occurring in ∼1 of 20 having markedly delayed onsets often eluding diagnosis. Frequent care visits and major morbidity are common. Survivorship recommendations should recognize the diverse neurological complications.

Clinical correlates of comorbid chronic tics and Tourette syndrome in a National Inpatient Children's Unit

2016 ◽  
Vol 33 (S1) ◽  
pp. S137-S137 ◽  
Author(s):  
S. Zinna ◽  
M. Kyriakopoulos
Keyword(s):  
Tourette Syndrome ◽  
Autism Spectrum ◽  
Clinical Notes ◽  
Clinical Correlates ◽  
Comorbid Diagnosis ◽  
History Of ◽  
Competing Interest ◽  
Neurodevelopmental Problems ◽  
Neuropsychiatric Conditions ◽  
Discharge Length

IntroductionChronic tics and Tourette syndrome (TS) can be comorbid with several neuropsychiatric conditions and may add to the complexity of children's clinical presentation and need for inpatient input.ObjectivesTo review the clinical notes of all children admitted to a National Children's Inpatient Unit (aged up to 12 years) over a 5-year period and analyse their demographic and clinical characteristics including the presence of chronic tics/TS.AimsTo assess the clinical correlates of comorbid chronic tics/TS in an inpatient preadolescent population.MethodsA retrospective naturalistic study of all patients admitted to our unit from 2009 to 2014 was conducted. Children with and without chronic tics/TS were compared in terms of age, gender, family history of mental illness, history of neurodevelopmental problems in siblings, medication on admission and at discharge, length of admission and functional outcomes using Chi2 and t-tests for categorical and continuous data respectively.ResultsA total of 133 children (mean age = 11.2 years) were included. Twenty-five (18.8%) were diagnosed with chronic tics/TS. Autism spectrum disorder was the most commonly comorbid diagnosis (84%), with the second most common being an anxiety disorder/OCD (52%). Statistically significant higher percentages of learning disability, neurodevelopmental problems in siblings, medication at discharge and longer inpatient admissions were identified in children with tics compared with the rest of the sample. No other differences were found.ConclusionsThe prevalence of chronic tics/TS in children needing inpatient treatment is significant. In our sample, chronic tics/TS seem to represent a marker of increased neurodevelopmental deviance and overall symptom severity.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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