623. Exploring ‘Slicer Dicer’, an Extraction Tool in EPIC, for Clinical and Epidemiological Analysis

Abstract Background Electronic Health Record (EHR) implementation has created an unprecedented library of patient data. Data extraction tools provide an opportunity to retrieve clinico-epidemiological information on a wide scale. Slicer Dicer is a data exploration tool in the EPIC EHR that allows one to customize searches on large patient populations. This software contains a variety of models that present de-identified information from EPIC’s Caboodle database. We explored the applicability and potential utility of this tool utilizing the diagnosis of Lyme disease as an example. Methods The following steps outline an overview of data extraction utilizing ICD-10 codes around Lyme disease at our health system. Step 1-3: Denominator chosen as ‘All Patients’ over a 3-year period, ‘Slicing’ of the data by ‘Lyme disease, unspecified’ was applied to these results, and the ‘sliced’ data was categorized by year of diagnosis (Slide 1). Step 4: This data was further arranged by month of diagnosis for trend analysis (Slide 2). Step 5: Sub-diagnosis was applied for Lyme arthritis (Slide 3). Step 6: Further ‘slicing’ was/can be done by other variables, such as ‘Hospitalization,’ ‘Encounter Diagnosis,’ and ‘ED Diagnosis’ (Slide 4). Step 7-8: Output was ‘sliced’ by ‘Age’ (Slide 5) and ‘Postal Code’ (Slide 6). Slide 1. EPIC EHR screen capture showing 3-year period data Data shown here represents 'All patients' chosen as the denominator further sliced by 'Lyme disease, unspecified' and categorized by the year of diagnosis. Slide 2. EPIC EHR screen capture showing data further arranged by month of diagnosis Results Macro-level data of period prevalence on Lyme disease over 3 years (Slide 1), seasonal trends (Slide 2), specific sub-diagnosis (Slide 3), output by setting of diagnosis (Slide 4), and demographic information of our patient population (Slides 5, 6) was revealed by application of these parameters. Slide 3. EPIC EHR screen capture showing application of sub-diagnosis for Lyme arthritis Slide 4. EPIC EHR screen capture showing further slicing by multiple variables like hospitalization and diagnosis Slide 5. EPIC EHR screen capture showing slicing of data by demographic information (Age) Conclusion Slicer Dicer can provide a snapshot for preliminary data analysis prior to investing time and commitment to a project. The appeal of this tool is that it mines de-identified data and thus does not require initial IRB approval. This opens an avenue for potential full research projects based on the results obtained and helps generate preliminary hypotheses through analysis of healthcare. Slide 6. EPIC EHR screen capture showing slicing of data by demographic information (Postal Code) Disclosures All Authors: No reported disclosures

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Arthritis and Diagnostics in Lyme Disease

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6010018 ◽

2021 ◽

Vol 6 (1) ◽

pp. 18

Author(s):

Javier A. Quintero ◽

Raluchukwu Attah ◽

Reena Khianey ◽

Eugenio Capitle ◽

Steven E. Schutzer

Keyword(s):

Lyme Disease ◽

Borrelia Burgdorferi ◽

Diagnostic Tests ◽

Laboratory Tests ◽

Diagnostic Methods ◽

Lyme Arthritis ◽

Differential Diagnoses ◽

Antibody Testing ◽

Active Infection ◽

Indirect Measure

The diagnosis of Lyme disease, caused by Borrelia burgdorferi, is clinical but frequently supported by laboratory tests. Lyme arthritis is now less frequently seen than at the time of its discovery. However, it still occurs, and it is important to recognize this, the differential diagnoses, and how laboratory tests can be useful and their limitations. The most frequently used diagnostic tests are antibody based. However, antibody testing still suffers from many drawbacks and is only an indirect measure of exposure. In contrast, evolving direct diagnostic methods can indicate active infection.

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Regulatory T Cells Contribute to Resistance against Lyme Arthritis

Infection and Immunity ◽

10.1128/iai.00160-20 ◽

2020 ◽

Vol 88 (11) ◽

Author(s):

Emily M. Siebers ◽

Elizabeth S. Liedhegner ◽

Michael W. Lawlor ◽

Ronald F. Schell ◽

Dean T. Nardelli

Keyword(s):

T Cells ◽

T Cell ◽

Lyme Disease ◽

Regulatory T Cells ◽

Regulatory T Cell ◽

Interleukin 10 ◽

Lyme Arthritis ◽

Interleukin 17 ◽

Content Type

ABSTRACT The symptoms of Lyme disease are caused by inflammation induced by species of the Borrelia burgdorferi sensu lato complex. The various presentations of Lyme disease in the population suggest that differences exist in the intensity and regulation of the host response to the spirochete. Previous work has described correlations between the presence of regulatory T cells and recovery from Lyme arthritis. However, the effects of Foxp3-expressing CD4+ T cells existing prior to, and during, B. burgdorferi infection have not been well characterized. Here, we used C57BL/6 “depletion of regulatory T cell” mice to assess the effects these cells have on the arthritis-resistant phenotype characteristic of this mouse strain. We showed that depletion of regulatory T cells prior to infection with B. burgdorferi resulted in sustained swelling, as well as histopathological changes, of the tibiotarsal joints that were not observed in infected control mice. Additionally, in vitro stimulation of splenocytes from these regulatory T cell-depleted mice resulted in increases in gamma interferon and interleukin-17 production and decreases in interleukin-10 production that were not evident among splenocytes of infected mice in which Treg cells were not depleted. Depletion of regulatory T cells at various times after infection also induced rapid joint swelling. Collectively, these findings provide evidence that regulatory T cells existing at the time of, and possibly after, B. burgdorferi infection may play an important role in limiting the development of arthritis.

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Postoperative Lyme Arthritis in the Orthopaedic Patient

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119845671 ◽

2019 ◽

Vol 11 (4) ◽

pp. 350-354

Author(s):

Matthew C. Hess ◽

Zachary Devilbiss ◽

Garry Wai Keung Ho ◽

Raymond Thal

Keyword(s):

United States ◽

Lyme Disease ◽

Postoperative Complication ◽

Joint Pain ◽

English Language ◽

The United States ◽

Lyme Arthritis ◽

Level Of Evidence ◽

Pubmed Database ◽

Level 3

Context:Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication.Evidence Acquisition:The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles.Study Design:Clinical review.Level of Evidence:Level 3.Results:A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature.Conclusion:These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis.Strength of Recommendation Taxonomy (SORT):C

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AB0903 LYME ARTHRITIS IN HIGH LYME DISEASE ENDEMIC EUROPE ZONE

10.1136/annrheumdis-2019-eular.1418 ◽

2019 ◽

Author(s):

Agnė Petrulionienė ◽

Daiva Radzišauskienė ◽

Arvydas Ambrozaitis ◽

Saulius Čaplinskas ◽

Algimantas Paulauskas ◽

...

Keyword(s):

Lyme Disease ◽

Lyme Arthritis

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Lyme Arthritis in Children on the Uptick in Western New York Area

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119890851 ◽

2019 ◽

Vol 12 ◽

pp. 117954411989085

Author(s):

Lauren N Lucente ◽

Aseel Abu-Dayya ◽

Teresa Hennon ◽

Shamim Islam ◽

Brian H Wrotniak ◽

...

Keyword(s):

Health Care ◽

New York ◽

Lyme Disease ◽

Clinical Features ◽

Health Care Providers ◽

Pediatric Population ◽

Geographic Area ◽

Rapid Onset ◽

Lyme Arthritis ◽

Care Providers

Objective: This study explores a suspected increasing incidence of Lyme arthritis in the Western New York pediatric population. In addition, we aim to describe a clinical picture of Lyme arthritis and the clinical features that distinguish it from other forms of arthritis. Methods: Patients diagnosed with Lyme arthritis between January 2014 and September 2018 were identified using International Classification of Diseases—10th Revision (ICD 10) codes for Lyme disease and Lyme arthritis. Patients were included in the study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, and (3) exhibited a positive Western blot. Results: A total of 22 patients were included in the study. There was a general trend toward an increasing number of cases of Lyme arthritis over the 45-month observation period. We identified 1 case in each 2014 and 2015, 4 cases in 2016, 7 in 2017, and 9 in the first 9 months of 2018. In total, 17 patients had arthritis as their only symptom at the time of diagnosis and 10 patients had a rash or a history that prompted suspicion of Lyme disease. The knee was the most frequent joint (86.4% of patients), and patients typically had 2 or fewer joints affected (86.4% of patients). Conclusions: A significant increase ( P = .02) in Lyme arthritis cases was observed at Oishei Children’s Hospital of Buffalo. Lyme arthritis may clinically present similarly to other forms of arthritis, such as oligoarticular juvenile idiopathic arthritis, so health care providers should be aware of distinguishing clinical features, which include rapid onset of swelling and patient age. Because the geographic area of endemic Lyme disease is expanding, all health care providers need to be aware of Lyme arthritis as a possible diagnosis.

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Examining Referral Patterns between Otolaryngology and Gastroenterology: A Window into Potential Inter-Specialty Knowledge Gaps

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420916215 ◽

2020 ◽

Vol 129 (8) ◽

pp. 801-805 ◽

Cited By ~ 1

Author(s):

Adam Haines ◽

Nikita Kohli ◽

Benjamin A. Lerner ◽

Michael Z. Lerner

Keyword(s):

Reflux Disease ◽

Laryngopharyngeal Reflux ◽

Data Extraction ◽

Level Of Evidence ◽

Referral Patterns ◽

Record Data ◽

Laryngopharyngeal Reflux Disease ◽

Icd 10 ◽

Looking Glass

Objective: The objective of this study was to examine referral patterns between otolaryngology and gastroenterology in order to delineate areas of clinical overlap, as well as to identify areas that might benefit from improved inter-specialty communication and collaboration. Methods: Montefiore’s Clinical Looking Glass tool was used to define parameters for electronic medical record data extraction from 2015 to 2018. Two cohorts were generated, one representing referrals placed by gastroenterology to otolaryngology and a second representing referrals placed by otolaryngology to gastroenterology. The ICD-10 codes in both cohorts were reviewed and 13 distinct “reason for referral” categories were defined. The rates of referral for each category were then calculated for each of the referral cohorts. Results: Otolaryngology referred to gastroenterology at a greater rate than gastroenterology referred to otolaryngology, despite seeing fewer total patients than gastroenterology. For referrals from gastroenterology to otolaryngology, the three most frequent referral reasons were oral cavity/oropharyngeal pathology (28.3%), dysphagia (28.3%), and gastroesophageal reflux disease/laryngopharyngeal reflux disease (GERD/LPRD) (11.3%). For referrals from otolaryngology to gastroenterology, the three most frequent referral reasons were GERD/LPRD (61.7%), dysphagia (18.6%), and esophageal pathology (5.3%). Conclusions: GERD/LPRD was more frequently referred out by otolaryngology than it was by gastroenterology, suggesting the need for further characterization of the discrepancy in management of a disease commonly treated by both specialties. The discrepant rates of referral for dysphagia also suggest a need to better understand what factors contribute to the differences in management of another clinical condition commonly assessed by both specialties. Level of Evidence: 4

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17 Lyme Disease in Eastern Ontario - A Paediatric Centre’s Experience from 2009-2018

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.016 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e6-e7

Author(s):

Stephanie Zahradnik ◽

Nick Barrowman ◽

Anne Tsampalieros ◽

Mary-Ann Harrison ◽

Jennifer Bowes ◽

...

Keyword(s):

Lyme Disease ◽

Laboratory Data ◽

Geographic Location ◽

Retrospective Chart Review ◽

Lyme Arthritis ◽

Annual Number ◽

Eastern Region ◽

Local Public Health ◽

Inpatient Ward ◽

Lyme Carditis

Abstract Background Lyme disease (LD) is caused by the tick-borne bacterium Borrelia burgdorferi. Over the past ten years, robust local public health data indicates that the incidence of LD has increased significantly in the eastern region of Ontario due to the spread of its vector, the blacklegged tick. As a result, we have seen an increase in the number of cases of LD in children at our tertiary paediatric centre, at all stages of infection. Familiarity with Lyme disease is important as incidence increases. We sought to characterize the cases at our centre. Objectives To describe the epidemiology of LD in children at our centre from 2009-2018, as well as the variety of clinical presentations of paediatric LD. Design/Methods We completed a retrospective chart review from 2009-2018 of all cases admitted or seen in the Infectious Disease (ID) clinic or the Emergency Department (ED) with a diagnosis of LD. Demographic, clinical and laboratory data were collected, including geographic location where infection occurred and resource utilization. We used descriptive statistics to describe cases and comparative statistics to determine changes in number of cases over time. Results There were 171 LD cases managed at our centre during this period. Mean age was 7.4 (SD 4.5) years, 89 (52.0%) were male. The annual number of cases from 2009 - 2018 increased from 1 to 44 and peaked in 2017 (47 cases). The highest number of cases occurred among children <6, the lowest in children ≥11. Most cases occurred in summer (60%), with the fewest in winter months (4%). Stage of LD was not documented in 1 case. Of the remainder, 98 (57.6%) cases were early localized, 41 (25.7%) early disseminated and 31 (19.7%) late disseminated LD. Early and late disseminated cases occurred more commonly in the summer and accounted for the majority of admissions. These included neurologic Lyme (lymphocytic meningitis [2, 1.2%], polyneuropathy [1, 0.6%], cranial nerve palsy [13, 7.6%]), Lyme carditis (5, 2.9%), and Lyme arthritis (29, 17.0%). There were 133 (77.8%) patients managed in ED, 66 (38.6%) in the ID clinic and 17 (9.9%) in the inpatient ward; median length of stay was 6 (IQR 5, 9) days, with a range of 1 to 30 days. The most common geographic locations of infection acquisition were Ottawa (120 cases, 71.0%) and Kingston (26, 15.4%). Conclusion Cases of LD managed at our paediatric centre have increased in keeping with population trends, with all LD stages experienced. Severe cases of meningitis, carditis, and arthritis resulted in hospitalization, with increasing numbers over the study period.

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Macrophage Polarization during Murine Lyme Borreliosis

Infection and Immunity ◽

10.1128/iai.00369-15 ◽

2015 ◽

Vol 83 (7) ◽

pp. 2627-2635 ◽

Cited By ~ 16

Author(s):

Carrie E. Lasky ◽

Rachel M. Olson ◽

Charles R. Brown

Keyword(s):

Lyme Disease ◽

Time Course ◽

Macrophage Polarization ◽

Lyme Arthritis ◽

Macrophage Phenotype ◽

Content Type ◽

C3h Mice ◽

Inflammatory Site ◽

Macrophage Subset ◽

Inflammatory Infiltrates

Infection of C3H mice withBorrelia burgdorferi, the causative agent of Lyme disease, reliably produces an infectious arthritis and carditis that peak around 3 weeks postinfection and then spontaneously resolve. Macrophage polarization has been suggested to drive inflammation, the clearance of bacteria, and tissue repair and resolution in a variety of infectious disease models. During Lyme disease it is clear that macrophages are capable of clearingBorreliaspirochetes and exhausted neutrophils; however, the role of macrophage phenotype in disease development or resolution has not been studied. Using classical (NOS2) and alternative (CD206) macrophage subset-specific markers, we determined the phenotype of F4/80+macrophages within the joints and heart throughout the infection time course. Within the joint, CD206+macrophages dominated throughout the course of infection, and NOS2+macrophage numbers became elevated only during the peak of inflammation. We also found dual NOS2+CD206+macrophages which increased during resolution. In contrast to findings for the ankle joints, numbers of NOS2+and CD206+macrophages in the heart were similar at the peak of inflammation. 5-Lipoxygenase-deficient (5-LOX−/−) mice, which display a failure of Lyme arthritis resolution, recruited fewer F4/80+cells to the infected joints and heart, but macrophage subset populations were unchanged. These results highlight differences in the inflammatory infiltrates during Lyme arthritis and carditis and demonstrate the coexistence of multiple macrophage subsets within a single inflammatory site.

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Serum epitope repertoire analysis enables early detection of Lyme disease with improved sensitivity in an expandable multiplex format

Journal of Clinical Microbiology ◽

10.1128/jcm.01836-20 ◽

2020 ◽

Author(s):

Jack Reifert ◽

Kathy Kamath ◽

Joel Bozekowski ◽

Ewa Lis ◽

Elizabeth J. Horn ◽

...

Keyword(s):

Lyme Disease ◽

Motif Discovery ◽

False Negative ◽

Serum Antibody ◽

High Sensitivity ◽

Bioinformatic Analysis ◽

Lyme Arthritis ◽

Igg Antibody ◽

Repertoire Analysis ◽

Validation Set

Widely employed diagnostic antibody serology for Lyme disease, known as standard two-tier testing (STTT), exhibits insufficient sensitivity in early Lyme disease yielding many thousands of false negative test results each year. Given this problem, we applied serum antibody repertoire analysis (SERA), or NGS-based serology, to discover IgG and IgM antibody epitope motifs capable of detecting Lyme disease specific antibodies with high sensitivity and specificity. Iterative motif discovery and bioinformatic analysis of epitope repertoires from subjects with Lyme disease (n = 264) and controls (n = 391) yielded a set of 28 epitope motifs representing 20 distinct IgG antibody epitopes, and set of 38 epitope motifs representing 21 distinct IgM epitopes which performed equivalently in a large validation cohort of STTT positive samples. In a second validation set from subjects with clinically-defined early Lyme disease (n=119) and controls (n = 257), the SERA Lyme IgG and IgM assay exhibited significantly improved sensitivity relative to STTT (77% vs. 62%, z-test, p = 0.013) and improved specificity (99% vs. 97%). Early Lyme disease subjects exhibited significantly fewer reactive epitopes (Mann-Whitney U-test, p < 0.0001), relative to subjects with Lyme arthritis. Thus, SERA Lyme IgG and M panels provided increased accuracy in early Lyme disease, in a readily expandable multiplex assay format.

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Prevalence of the Z515 (Palliative Care) Diagnosis from the ICD-10 System in Cancer Patients and the Relationship between Treatment and Cost in Songklanagarind Hospital

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201824 ◽

2018 ◽

Vol 36 (4) ◽

Author(s):

Orapan Fumaneeshoat

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Average Cost ◽

Data Extraction ◽

Diagnostic System ◽

Healthcare Services ◽

Diagnostic Code ◽

Icd 10 ◽

The Government ◽

The Relationship

Objective: To determine the prevalence of use of the diagnostic system ICD-10 code Z515 in patients diagnosed with cancer and the relationship between treatment and cost in Songklanagarind Hospital during the 2012-2016 period. Material and Methods: A retrospective descriptive study was performed in patients who were diagnosed as code Z515 in Songklanagarind Hospital from 2012-2016. Data were collected through the Hospital Information System (HIS), and the patients were divided into 2 groups based on whether they were Inpatient Department (IPD) or Outpatient Department (OPD). From the HIS, data concerning sex, age, the right of access to healthcare services, date of diagnosis, first and last department that diagnosed the Z515 code, other departments that diagnosed the same code, other codes diagnosed besides Z515, the latest treatment received, number of regularly-used medications, symptoms that persisted according to the most recent record, ward name, duration of hospitalization (for IPD cases), and the average cost of treatment were recorded on data extraction forms and analyzed as percentages with 95% confidence interval and odds ratios. Results: The prevalence of the diagnostic code Z515 in cancer patients during the study period was 0.2% in both inand outpatients. For outpatient the relationship between average cost and number of medications and average cost and type of treatment were statistically significantly different, while for inpatients the difference was not statistically significant. Conclusion: In Songklanagarind Hospital the use of code Z515 is very low, even though we know that all cancer patients should get the best palliative care support and the earlier we diagnose them as palliative, the better the care they will receive. Therefore, if the doctors are aware of this code, the patient will receive the best care in their end stages of life, and that would make them and their families feel happier. Moreover, our hospital will get reimbursement from the government to get more resources. Hence, more patients can be helped. Songklanagarind Hospital should undertake some kind of program to ensure all physicians are aware of code Z515 and how to use it in order to provide the best care for end-of-life patients.

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