scholarly journals Comparative analysis of methods for identifying multimorbidity patterns: a study of ‘real-world’ data

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018986 ◽  
Author(s):  
Albert Roso-Llorach ◽  
Concepción Violán ◽  
Quintí Foguet-Boreu ◽  
Teresa Rodriguez-Blanco ◽  
Mariona Pons-Vigués ◽  
...  
Keyword(s):  
Real World ◽  
Hierarchical Cluster ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Real World Data ◽  
Cross Sectional ◽  
World Data ◽  
Data Usage ◽  
Classification Of Diseases ◽  
Depth Study

ObjectiveThe aim was to compare multimorbidity patterns identified with the two most commonly used methods: hierarchical cluster analysis (HCA) and exploratory factor analysis (EFA) in a large primary care database. Specific objectives were: (1) to determine whether choice of method affects the composition of these patterns and (2) to consider the potential application of each method in the clinical setting.DesignCross-sectional study. Diagnoses were based on the 263 corresponding blocks of the International Classification of Diseases version 10. Multimorbidity patterns were identified using HCA and EFA. Analysis was stratified by sex, and results compared for each method.Setting and participantsElectronic health records for 408 994 patients with multimorbidity aged 45–64 years in 274 primary health care teams from 2010 in Catalonia, Spain.ResultsHCA identified 53 clusters for women, with just 12 clusters including at least 2 diagnoses, and 15 clusters for men, all of them including at least two diagnoses. EFA showed 9 factors for women and 10 factors for men. We observed differences by sex and method of analysis, although some patterns were consistent. Three combinations of diseases were observed consistently across sex groups and across both methods: hypertension and obesity, spondylopathies and deforming dorsopathies, and dermatitis eczema and mycosis.ConclusionsThis study showed that multimorbidity patterns vary depending on the method of analysis used (HCA vs EFA) and provided new evidence about the known limitations of attempts to compare multimorbidity patterns in real-world data studies. We found that EFA was useful in describing comorbidity relationships and HCA could be useful for in-depth study of multimorbidity. Our results suggest possible applications for each of these methods in clinical and research settings, and add information about some aspects that must be considered in standardisation of future studies: spectrum of diseases, data usage and methods of analysis.

scholarly journals Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)

2021 ◽  
Vol 18 (5) ◽  
pp. 2244
Author(s):  
M. Rosa Dalmau Llorca ◽  
Carina Aguilar Martín ◽  
Noèlia Carrasco-Querol ◽  
Zojaina Hernández Rojas ◽  
Emma Forcadell Drago ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Real World ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Real World Data ◽  
Cross Sectional ◽  
World Data

Background: Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results: In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions: Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.

scholarly journals Colchicine Use Is Associated with Decreased Prevalence of Myocardial Infarction in Patients with Gout

2012 ◽  
Vol 39 (7) ◽  
pp. 1458-1464 ◽  
Author(s):  
DARIA B. CRITTENDEN ◽  
R. AARON LEHMANN ◽  
LAURA SCHNECK ◽  
ROBERT T. KEENAN ◽  
BINITA SHAH ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
New York ◽  
Statistical Significance ◽  
International Classification Of Diseases ◽  
Serum Urate ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Classification Of Diseases ◽  
Level Versus

Objective.The ability of antiinflammatory strategies to alter cardiovascular risk has not been rigorously examined. Colchicine is an antiinflammatory agent that affects macrophages, neutrophils, and endothelial cells, all of which are implicated in the pathogenesis of cardiovascular disease. We examined whether colchicine use was associated with a reduced risk of myocardial infarction (MI) in patients with gout.Methods.We conducted a retrospective, cross-sectional study of all patients with an International Classification of Diseases, 9th ed, code for gout in the electronic medical record (EMR) of the New York Harbor Healthcare System Veterans Affairs network and ≥ 1 hospital visit between August 2007 and August 2008. Hospital pharmacy data were used to identify patients who had filled at least 1 colchicine prescription versus those who had not. Demographics and CV comorbidities were collected by EMR review. The primary outcome was diagnosis of MI. Secondary outcomes included all-cause mortality and C-reactive protein (CRP) level.Results.In total, 1288 gout patients were identified. Colchicine (n = 576) and no colchicine (n = 712) groups had similar baseline demographics and serum urate levels. Prevalence of MI was 1.2% in the colchicine versus 2.6% in the no-colchicine group (p = 0.03). Colchicine users also had fewer deaths and lower CRP levels, although these did not achieve statistical significance. Colchicine effects persisted when allopurinol users were excluded from the analysis.Conclusion.In this hypothesis-generating study, gout patients who took colchicine had a significantly lower prevalence of MI and exhibited trends toward reduced all-cause mortality and lower CRP level versus those who did not take colchicine.

scholarly journals DEPRESSION AND ANXIETY IN CORRELATION TO BODY AREAS INVOLVED IN PATIENTS OF BURNS

2021 ◽  
Vol 71 (3) ◽  
pp. 734-38
Author(s):  
Ghazanfar Ali ◽  
Sikander Ali Khan ◽  
Muzzafar Ahmed ◽  
Muhammad Sheraz Afzal Malik ◽  
Danish Almas ◽  
...  
Keyword(s):  
Severe Depression ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Military Hospital ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
High Prevalence ◽  
Classification Of Diseases ◽  
Burns Unit

Objective: To evaluate the severity of depression and anxiety among patients of burns and correlate depression and anxiety with areas of body involved in burns. Study Design: A cross-sectional study. Place and Duration of Study: The departments of Psychiatry and department of Plastic Surgery, Combined Military Hospital Multan, from Oct 2019 to Mar 2020. Methodology: Through consecutive sampling, 56 patients of burns reporting to burns unit were assessed for anxiety and/ or depression based on the diagnostic criteria of International Classification of Diseases version 10. Symptom severity was assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety. Descriptive statistics like mean with standard deviation was calculated for age. Frequency along with percentages was calculated for sociodemographic variables, Anxiety and depression. Results: Depression was present among 30 (53%) of participants out of which 16 (53.5%) had mild, 11 (37.9%) had moderate while only 3 (12.5%) had severe depression. Anxiety was seen among 50 (89%) of participants out of which sixteen (32.1%) had mild, 26 (51.7%) had moderate while 8 (16%) had severe anxiety. Significant correlation existed among the major area involved in burn with both anxiety and depression (p<0.01). Conclusion: There is a very high prevalence of anxiety and depression among patients of burn. Significant positive correlation existed between the level of anxiety and the areas involved in burns.

scholarly journals Incidence, prevalence, and demographic characteristics of ocular cicatricial pemphigoid in Colombia: data from the National Health Registry 2009-2019

2021 ◽  
Vol 14 (11) ◽  
pp. 1765-1770
Author(s):  
Carlos Cifuentes-González ◽  
◽  
Juliana Reyes-Guanes ◽  
Pilar Uribe-Reina ◽  
Alejandra de-la-Torre ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Cicatricial Pemphigoid ◽  
Cross Sectional ◽  
Female Ratio ◽  
Incidence Data ◽  
Ocular Cicatricial Pemphigoid ◽  
Classification Of Diseases ◽  
Ocular Pemphigoid ◽  
Health Registry

AIM: To provide an epidemiological characterization of ocular cicatricial pemphigoid (OCP) in Colombia. METHODS: We conducted a cross-sectional study using SISPRO. We applied the specific code of the International Classification of Diseases for Ocular Pemphigoid, from 2009-2019 to estimate prevalence, incidence, and the demographic status of the disease in Colombia. RESULTS: The estimated average prevalence was 0.22 per 1 000 000 inhabitants, and the estimated average incidence was 0.24 per 1 000 000 inhabitants. With a female predominance of 62.5%, and a male/female ratio of 1:1.6. The group of patients diagnosed with the disease after the age of 80 presented the highest prevalence. The departments with the highest prevalence were Antioquia, Bogotá, and Santander. CONCLUSION: There are important differences between worldwide and Colombian prevalence and incidence data, which may be related to genetic and epigenetic factors, and the possible underdiagnosis of the disease. According to the results, OCP is an extremely rare disease in Colombia. Nevertheless, it is important to encourage awareness of the disease due to its devastating consequences.

OPIOID PRESCRIBING AMONG OUTPATIENTS WITH RHEUMATOID ARTHRITIS

Pain Medicine ◽  
2021 ◽  
Author(s):  
Yinan Huang ◽  
Sanika Rege ◽  
Satabdi Chatterjee ◽  
Rajender R Aparasu
Keyword(s):  
Rheumatoid Arthritis ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Office Visits ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Classification Of Diseases

Abstract Study Objectives To examine the outpatient opioid prescribing practices and the factors associated with opioid prescriptions in patients with Rheumatoid Arthritis (RA). Design This cross-sectional study used the 2011-2016 National Ambulatory Medical Care Survey. Descriptive weighted analyses were used to examine the trends in opioid prescribing practices for RA. Multivariable logistic regression was used to examine the factors associated with opioid prescriptions among RA visits. Subjects Adult patients with a primary diagnosis of RA based on the International Classification of Diseases Results According to the national surveys, an average of 4.45 (95% Confidence Interval [CI], 2.30-6.60) million office visits were made annually for RA. Approximately 24.28% of these visits involved opioid prescriptions. The RA visits involving opioid prescriptions increased from 1.43 million in 2011-2012 to 3.69 million in 2015-2016 (P &lt; 0.0001). Being in the age group of 50-64 years (odds ratio [OR] = 3.40; 95% CI, 1.29-9.00), being Hispanic or Latino (OR = 2.92, 95% CI, 1.10-7.74), visiting primary physician (OR = 4.67; 95% CI, 1.86-11.75), muscle relaxants (OR = 64.32; 95% CI, 9.71-426.09), acetaminophen (OR = 93.40; 95% CI, 26.19-333.04), antidepressants (OR = 6.10; 95% CI, 2.63-14.14), and glucocorticoids (OR = 3.20; 95% CI, 1.61-6.38) were associated with an increased likelihood of receiving opioid prescriptions in RA. Conclusions One in four adult RA visits resulted in opioid prescriptions, and the opioid visits rate more than doubled during the study period. Several patient and provider factors were associated with the opioid prescribing among RA visits. Understanding these prescribing practices can help to devise strategies for safe opioid prescribing practices in RA.

Quantifying the diagnostic pathway for patients with cognitive impairment: real-world data from Australia

2019 ◽  
Vol 32 (5) ◽  
pp. 601-610
Author(s):  
Christopher M. Black ◽  
Michael Woodward ◽  
Baishali M. Ambegaonkar ◽  
Alana Philips ◽  
James Pike ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Real World ◽  
Public Awareness ◽  
Cross Sectional Survey ◽  
Real World Data ◽  
Cross Sectional ◽  
World Data ◽  
Diagnostic Pathway ◽  
Initial Symptoms ◽  
Mean Time

ABSTRACTObjectives:Rapid diagnosis of dementia is essential to ensure optimum patient care. This study used real-world data to quantify the dementia diagnostic pathway in Australia.Design:A real-world, cross-sectional survey of physicians and patients.Setting:Clinical practice.Participants:Primary care or specialist physicians managing patients with cognitive impairment (CI).Measurements:Descriptive analyses focused on key events in the diagnostic pathway. Regression modeling compared the duration between first consultation and formal diagnosis with various factors.Results:Data for 600 patients were provided by 60 physicians. Mean time from initial symptoms to first consultation was 6.1 ± 4.4 months; 20% of patients had moderate or severe CI at first consultation. Mean time from first consultation to formal diagnosis was 4.0 ± 7.4 months (1.2 ± 3.6 months if not referred to a secondary physician, and 5.3 ± 8.3 months if referred). Time from first consultation to diagnosis was significantly associated with CI severity at first consultation; time was shorter with more severe CI. There was no association of disease severity and referral to a secondary physician; 69.5% of patients were referred, the majority (57.1%) to a geriatrician. The highest proportion of patients were diagnosed by geriatricians (47.4%). Some form of test or scale was used to aid diagnosis in 98.8% of patients.Conclusions:A substantial number of Australians experience cognitive decline and behavioral changes some time before consulting a physician or being diagnosed with dementia. Increasing public awareness of the importance of early diagnosis is essential to improve the proportion of patients receiving comprehensive support prior to disease progression.

scholarly journals Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019407 ◽  
Author(s):  
Amy E Peden ◽  
Richard C Franklin ◽  
Alison J Mahony ◽  
Justin Scarr ◽  
Paul D Barnsley
Keyword(s):  
Causes Of Death ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Life Saving ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Underlying Causes ◽  
Icd Codes ◽  
Underlying Cause Of Death

ObjectivesFatal drowning estimates using a single underlying cause of death (UCoD) may under-represent the number of drowning deaths. This study explores how data vary by International Classification of Diseases (ICD)-10 coding combinations and the use of multiple underlying causes of death using a national register of drowning deaths.DesignAn analysis of ICD-10 external cause codes of unintentional drowning deaths for the period 2007–2011 as extracted from an Australian total population unintentional drowning database developed by Royal Life Saving Society—Australia (the Database). The study analysed results against three reporting methodologies: primary drowning codes (W65-74), drowning-related codes, plus cases where drowning was identified but not the UCoD.SettingAustralia, 2007–2011.ParticipantsUnintentional fatal drowning cases.ResultsThe Database recorded 1428 drowning deaths. 866 (60.6%) had an UCoD of W65-74 (accidental drowning), 249 (17.2%) cases had an UCoD of either T75.1 (0.2%), V90 (5.5%), V92 (3.5%), X38 (2.4%) or Y21 (5.9%) and 53 (3.7%) lacked ICD coding. Children (aged 0–17 years) were closely aligned (73.9%); however, watercraft (29.2%) and non-aquatic transport (13.0%) were not. When the UCoD and all subsequent causes are used, 67.2% of cases include W65-74 codes. 91.6% of all cases had a drowning code (T75.1, V90, V92, W65-74, X38 and Y21) at any level.ConclusionDefining drowning with the codes W65-74 and using only the UCoD captures 61% of all drowning deaths in Australia. This is unevenly distributed with adults, watercraft and non-aquatic transport-related drowning deaths under-represented. Using a wider inclusion of ICD codes, which are drowning-related and multiple causes of death minimises this under-representation. A narrow approach to counting drowning deaths will negatively impact the design of policy, advocacy and programme planning for prevention.

scholarly journals Diagnoses and Procedures of Inpatients with Female Genital Mutilation/Cutting in Swiss University Hospitals: A Cross-Sectional Study

2021 ◽  
Author(s):  
Mathilde Horowicz ◽  
Sara Cottler-Casanova ◽  
Jasmine Abdulcadir
Keyword(s):  
Female Genital Mutilation ◽  
International Classification Of Diseases ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
University Hospitals ◽  
Cross Sectional ◽  
Genital Mutilation ◽  
Classification Of Diseases ◽  
Women And Girls ◽  
Female Genital

Abstract Background: Female genital mutilation/Cutting (FGM/C) can result in short and long-term complications, which can impact physical, psychological and sexual health. Our objective was to obtain descriptive data about the most frequent health conditions and procedures associated with FGM/C in Swiss university hospitals inpatient women and girls with a diagnosis of FGM/C. Our research focused on the gynaecology and obstetrics departments. Methods: We conducted an exploratory descriptive study to identify the health outcomes of women and girls with a coded FGM/C diagnose who had been admitted to Swiss university hospitals between 2016 and 2018. Four of the five Swiss university hospitals provided anonymized data on primary and secondary diagnoses coded with the International Classification of Diseases (ICD) and interventions coded in their medical files. Results: Between 2016 and 2018, 207 inpatients had a diagnosis of FGM/C. The majority (96%) were admitted either to gynaecology or obstetrics divisions with few genito-urinary and psychosexual conditions coded.Conclusions: FGM/C coding capacities in Swiss university hospitals are low, and some complications of FGM/C are probably not diagnosed. Pregnancy and delivery represent key moments to identify and offer medical care to women and girls who live with FGM/C. Trial registration: This cross-sectional study (protocol number 2018-01851) was conducted in 2019, and approved by the Swiss ethics committee.

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