Where Does Telemedicine Fit into Otolaryngology? An Assessment of Telemedicine Eligibility among Otolaryngology Diagnoses

2018 ◽  
Vol 158 (4) ◽  
pp. 641-644 ◽  
Author(s):  
Ryan R. McCool ◽  
Louise Davies
Keyword(s):  
Rural Areas ◽  
External Ear ◽  
Current Procedural Terminology ◽  
Round Trip ◽  
Eligibility Criteria ◽  
International Classification Of Disease ◽  
Problem Types ◽  
Improve Access ◽  
Nose And Throat

Telemedicine applications are expanding to improve access to specialty care in rural areas. Telemedicine is not routinely used to evaluate new patients in otolaryngology, and it remains unclear which patients could benefit from this technology. This study estimates the rate of telemedicine eligibility among specific otolaryngology diagnoses. We conducted a retrospective cohort study of all ear, nose, and throat consults between August 1, 2013, and July 31, 2015. We paired diagnoses ( International Classification of Disease, Ninth Revision) with office-based procedures ( Current Procedural Terminology) and applied prespecified telemedicine eligibility criteria to encounters retroactively. If a specialized procedure was necessary to reach a diagnosis, the diagnosis was considered ineligible for telemedicine. We found that 62% of otolaryngology encounters would likely be eligible for telemedicine. Patients with inner and middle ear problems were more likely eligible for telemedicine, while patients with problems affecting the larynx and external ear were least likely eligible. Nearly 90% of veterans drove >1 hour round-trip for services. Understanding which otolaryngology problem types are more frequently eligible for telemedicine may assist those who are planning to implement a telemedicine program.

scholarly journals Genetic testing utilization for patients with neurologic disease and the limitations of claims data

2020 ◽  
Vol 6 (2) ◽  
pp. e405
Author(s):  
Samuel J. Mackenzie ◽  
Chun Chieh Lin ◽  
Peter K. Todd ◽  
James F. Burke ◽  
Brian C. Callaghan
Keyword(s):  
Genetic Testing ◽  
Claims Data ◽  
Private Insurance ◽  
Neurologic Disease ◽  
Current Procedural Terminology ◽  
Cross Sectional ◽  
International Classification Of Disease ◽  
High Prevalence ◽  
Health Care Claims

ObjectiveTo determine the utilization of genetic testing in patients seen by a neurologist within a large private insurance population.MethodsUsing the Optum health care claims database, we identified a cross-sectional cohort of patients who had been evaluated by a neurologist no more than 30 days before initial genetic testing. Within this group, we then categorized genetic testing between 2014 and 2016 on the basis of the Current Procedural Terminology (CPT) codes related to molecular and genetic testing. We also evaluated the International Classification of Disease Version 9 Clinical Code Classifications (ICD-9 CCS) associated with testing.ResultsFrom 2014 to 2016, a total of 45,014 claims were placed for 29,951 patients who had been evaluated by a neurologist within the preceding 30 days. Of these, 29,926 (66.5%) were associated with codes that were too nonspecific to infer what test was actually performed. Among those claims where the test was clearly identifiable, 7,307 (16.2%) were likely obtained for purposes of neurologic diagnosis, whereas the remainder (17.2%) was obtained for non-neurological purposes. An additional 3,793 claims (8.4%) wherein the test ordered could not be clearly identified were associated with a neurology-related ICD-9 CCS.ConclusionsAccurate assessment of genetic testing utilization using claims data is not possible given the high prevalence of nonspecific codes. Reducing the ambiguity surrounding the CPT codes and the actual testing performed will become even more important as more genetic tests become available.

Future Directions

2020 ◽  
pp. 476-479
Author(s):  
Marc N. Potenza ◽  
Kyle A. Faust ◽  
David Faust
Keyword(s):  
Technology Development ◽  
Digital Technologies ◽  
World Health ◽  
International Classification Of Disease ◽  
Levels Of Use ◽  
Pornography Use ◽  
Negative Impacts ◽  
Mental Health Treatments ◽  
The Many

As digital technology development continues to expand, both its positive and negative applications have also grown. As such, it is essential to continue gathering data on the many types of digital technologies, their overall effects, and their impact on public health. The World Health Organization’s inclusion of Gaming Disorder in the eleventh edition of the International Classification of Disease (ICD-11) indicates that some of the problematic effects of gaming are similar to those of substance-use disorders and gambling. Certain behaviors easily engaged in via the internet may also lead to compulsive levels of use in certain users, such as shopping or pornography use. In contrast, digital technologies can also lead to improvements in and wider accessibility to mental health treatments. Furthermore, various types of digital technologies can also lead to benefits such as increased productivity or social functioning. By more effectively understanding the impacts of all types of digital technologies, we can aim to maximize their benefits while minimizing or preventing their negative impacts.

scholarly journals A Capabilities-Led Approach to Assessing Technological Solutions for a Rural Community

Energies ◽  
2021 ◽  
Vol 14 (5) ◽  
pp. 1398
Author(s):  
Xinfang Wang ◽  
Rosie Day ◽  
Dan Murrant ◽  
Antonio Diego Marín ◽  
David Castrejón Botello ◽  
...  
Keyword(s):  
Rural Community ◽  
Rural Areas ◽  
Assessment Method ◽  
Unintended Consequences ◽  
Energy Services ◽  
Grid Systems ◽  
Technological Interventions ◽  
Solution Design ◽  
Improve Access

To improve access to affordable, reliable and sustainable energy in rural areas of the global south, off-grid systems using renewable generation and energy storage are often proposed. However, solution design is often technology-driven, with insufficient consideration of social and cultural contexts. This leads to a risk of unintended consequences and inappropriate systems that do not meet local needs. To address this problem, this paper describes the application of a capabilities-led approach to understanding a community’s multi-dimensional energy poverty and assessing their needs as they see them, in order to better design suitable technological interventions. Data were collected in Tlamacazapa, Mexico, through site visits and focus groups with men and women. These revealed the ways in which constrained energy services undermined essential capabilities, including relating to health, safety, relationships and earning a living, and highlighted the specific ways in which improved energy services, such as lighting, cooking and mechanical power could improve capabilities in the specific context of Tlamacazapa. Based on these findings, we propose some potential technological interventions to address these needs. The case study offers an illustration of an assessment method that could be deployed in a variety of contexts to inform the design of appropriate technological interventions.

scholarly journals Automated classification of clinical trial eligibility criteria text based on ensemble learning and metric learning

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Kun Zeng ◽  
Yibin Xu ◽  
Ge Lin ◽  
Likeng Liang ◽  
Tianyong Hao
Keyword(s):  
Clinical Trial ◽  
Ensemble Learning ◽  
Metric Learning ◽  
Classification Performance ◽  
Ensemble Model ◽  
Automated Classification ◽  
Eligibility Criteria ◽  
Data Imbalance ◽  
The Impact

Abstract Background Eligibility criteria are the primary strategy for screening the target participants of a clinical trial. Automated classification of clinical trial eligibility criteria text by using machine learning methods improves recruitment efficiency to reduce the cost of clinical research. However, existing methods suffer from poor classification performance due to the complexity and imbalance of eligibility criteria text data. Methods An ensemble learning-based model with metric learning is proposed for eligibility criteria classification. The model integrates a set of pre-trained models including Bidirectional Encoder Representations from Transformers (BERT), A Robustly Optimized BERT Pretraining Approach (RoBERTa), XLNet, Pre-training Text Encoders as Discriminators Rather Than Generators (ELECTRA), and Enhanced Representation through Knowledge Integration (ERNIE). Focal Loss is used as a loss function to address the data imbalance problem. Metric learning is employed to train the embedding of each base model for feature distinguish. Soft Voting is applied to achieve final classification of the ensemble model. The dataset is from the standard evaluation task 3 of 5th China Health Information Processing Conference containing 38,341 eligibility criteria text in 44 categories. Results Our ensemble method had an accuracy of 0.8497, a precision of 0.8229, and a recall of 0.8216 on the dataset. The macro F1-score was 0.8169, outperforming state-of-the-art baseline methods by 0.84% improvement on average. In addition, the performance improvement had a p-value of 2.152e-07 with a standard t-test, indicating that our model achieved a significant improvement. Conclusions A model for classifying eligibility criteria text of clinical trials based on multi-model ensemble learning and metric learning was proposed. The experiments demonstrated that the classification performance was improved by our ensemble model significantly. In addition, metric learning was able to improve word embedding representation and the focal loss reduced the impact of data imbalance to model performance.

scholarly journals Neue Terminologie für Sprachentwicklungsstörungen?

2021 ◽  
Author(s):  
K. Neumann ◽  
B. Arnold ◽  
A. Baumann ◽  
C. Bohr ◽  
H. A. Euler ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
International Classification ◽  
International Classification Of Disease ◽  
Diagnostik Und Therapie ◽  
Classification Of Diseases ◽  
Icd 10

Zusammenfassung Hintergrund Sprachtherapeutisch-linguistische Fachkreise empfehlen die Anpassung einer von einem internationalen Konsortium empfohlenen Änderung der Nomenklatur für Sprachstörungen im Kindesalter, insbesondere für Sprachentwicklungsstörungen (SES), auch für den deutschsprachigen Raum. Fragestellung Ist eine solche Änderung in der Terminologie aus ärztlicher und psychologischer Sicht sinnvoll? Material und Methode Kritische Abwägung der Argumente für und gegen eine Nomenklaturänderung aus medizinischer und psychologischer Sicht eines Fachgesellschaften- und Leitliniengremiums. Ergebnisse Die ICD-10-GM (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification) und eine S2k-Leitlinie unterteilen SES in umschriebene SES (USES) und SES assoziiert mit anderen Erkrankungen (Komorbiditäten). Die USES- wie auch die künftige SES-Definition der ICD-11 (International Classification of Diseases 11th Revision) fordern den Ausschluss von Sinnesbehinderungen, neurologischen Erkrankungen und einer bedeutsamen intellektuellen Einschränkung. Diese Definition erscheint weit genug, um leichtere nonverbale Einschränkungen einzuschließen, birgt nicht die Gefahr, Kindern Sprach- und weitere Therapien vorzuenthalten und erkennt das ICD(International Classification of Disease)-Kriterium, nach dem der Sprachentwicklungsstand eines Kindes bedeutsam unter der Altersnorm und unterhalb des seinem Intelligenzalter angemessenen Niveaus liegen soll, an. Die intendierte Ersetzung des Komorbiditäten-Begriffs durch verursachende Faktoren, Risikofaktoren und Begleiterscheinungen könnte die Unterlassung einer dezidierten medizinischen Differenzialdiagnostik bedeuten. Schlussfolgerungen Die vorgeschlagene Terminologie birgt die Gefahr, ätiologisch bedeutsame Klassifikationen und differenzialdiagnostische Grenzen zu verwischen und auf wertvolles ärztliches und psychologisches Fachwissen in Diagnostik und Therapie sprachlicher Störungen im Kindesalter zu verzichten.

Is Cauda Equina Syndrome Being Treated Within the Recommended Time Frame?

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1520-1526 ◽  
Author(s):  
Robert T. Arrigo ◽  
Paul Kalanithi ◽  
Maxwell Boakye
Keyword(s):  
Cauda Equina Syndrome ◽  
Medical Condition ◽  
Cauda Equina ◽  
Time Frame ◽  
Current Guideline ◽  
International Classification Of Disease ◽  
Lumbar Disk ◽  
Urgent Surgery ◽  
Spine Surgeon

Abstract BACKGROUND: Cauda equina syndrome (CES) is a rare but devastating medical condition requiring urgent surgery to halt or reverse neurological compromise. Controversy exists as to how soon surgery must be performed after diagnosis, and clinical and medicolegal factors make this question highly relevant to the spine surgeon. It is unclear from the literature how often CES patients are treated within the recommended time frame. OBJECTIVE: To determine whether CES patients are being treated in compliance with the current guideline of surgery within 48 hours and to assess incidence, demography, comorbidities, and outcome measures of CES patients. METHODS: We searched the 2003 to 2006 California State Inpatient Databases to identify degenerative lumbar disk disorder patients surgically treated for CES. An International Classification of Disease, ninth revision, clinical modification, diagnosis code was used to identify CES patients with advanced disease. RESULTS: The majority (88.74%) of California's CES patients received surgery within the recommended 48-hour window after diagnosis. The incidence of CES in surgically treated degenerative lumbar disk patients was 1.51% with an average of 397 cases per year in California. CES patients had worse outcomes and used more healthcare resources than other surgically treated degenerative lumbar disk patients; this disparity was more pronounced for patients with advanced CES. CES patients treated after 48 hours had 3 times the odds of a nonroutine discharge as patients treated within 48 hours (odds ratio = 3.082; P < .001). CONCLUSION: In California, patients are being treated within the recommended 48-hour time frame.

Risk Adjustment in Outcome Assessment: the Charlson Comorbidity Index

1993 ◽  
Vol 32 (05) ◽  
pp. 382-387 ◽  
Author(s):  
C. Sicotte ◽  
C. Tilquin ◽  
W. D’Hoore
Keyword(s):  
Risk Adjustment ◽  
Predictive Accuracy ◽  
Charlson Index ◽  
Administrative Databases ◽  
Receiver Operating Curve ◽  
Multiple Logistic Regression ◽  
Principal Diagnosis ◽  
International Classification Of Disease ◽  
Comorbidity Index

AbstractTo measure the burden of comorbid diseases using the MED-ECHO database (Quebec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in a group of 62,456 patients having one of the following conditions: ischemic heart disease, congestive heart failure, stroke, or bacterial pneumonia. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. When gender, age, comorbidity and the principal diagnoses were taken into account, the area under the receiver-operating curve was 0.83. Therefore, the Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases.

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