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.

Characterization of Electroencephalographic Findings at an Electrodiagnostic Unit of a Tertiary Hospital, North-central Nigeria

2021 ◽  
Vol 2 (1) ◽  
pp. 49-55
Author(s):  
E U Iwuozo ◽  
J O Enyikwola ◽  
I O Obekpa ◽  
O O Ijachi ◽  
A A Godwin ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Seizure Disorder ◽  
Cross Sectional ◽  
North Central ◽  
Younger Age ◽  
High Prevalence ◽  
Diagnosis And Classification ◽  
Age Range

Electroencephalography (EEG) remains an important investigative tool in supporting the diagnosis and classification of various seizure types. We sought to examine and characterize the EEG findings from all patients referred for the procedure. This cross-sectional retrospective study was carried out at an EEG unit in Federal Medical Centre, Makurdi, Benue State, North Central Nigeria from May 2016 to December 2020. Relevant patients' information were extracted and analysed using SPSS version 21. A total of 484 patients were seen over the study period with age range of 1-87 years and median age of 23 years. They comprised of 254 (52.5%) male and 230 (47.5%) female. The psychiatrist and the Physicians/Neurologist referred most of them for EEG, 201 (41.5%) and 124 (25.6%) respectively. The most reported indication for EEG was clinical suspicion of seizure disorder 291 (60.1%), whilst some did not have a clear indication 111 (22.9%). About 417 (86.2%) of our patients had abnormal EEG finding out of which 414 (99.3%) were diagnostic of seizure disorder made up of generalized seizure in 255 (61.6%) and focal seizure in 159 (38.4%). About 237 (48.9%) of them were already on antiepileptic drugs (AEDs) at referral of which 190 (80.2%0 were taking carbamazepine. This study showed a high prevalence of abnormal EEG with most of them diagnostic of seizure disorder especially generalized seizure. They were mostly of younger age group with about half of them already on AEDs at referral, majority of who were sent by the Psychiatrist.

Abstract 2847: High Prevalence of ’Unclassifiable’ Diastolic Dysfunction Using Current Criteria

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Arumugam Narayanan ◽  
Gerard P Aurigemma ◽  
Jeffrey C Hill ◽  
Jennifer Kane ◽  
Allison McNamee ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Classification Scheme ◽  
Tissue Doppler ◽  
Cross Sectional ◽  
High Prevalence ◽  
Doppler Data ◽  
Pulmonary Vein Flow ◽  
Classification Variable ◽  
Deceleration Time

Background: Cross sectional studies have shown that diastolic dysfunction is prevalent and impacts mortality. Classification of diastolic function (DF) requires several Doppler variables. However, in clinical practice, pts may not necessarily have concordant data, leading to confusion about classification. The issue is compounded in hospitalized patients, who are tachycardic and may have limited Doppler data. Objective: The aims of this study were (1) to determine the percentage of pts with measurable DF data, and (2) to determine the percentage of pts with concordant data. Methods: Data from 100 consecutive in- and outpts in sinus rhythm, compiled by a single experienced sonographer were reviewed; transmitral (E/A), deceleration time (DT), pulmonary vein flow - S/D ratio and A reversal duration (PV A dur), and tissue Doppler E’ were attempted in all. DF was classified as normal, or mild, moderate or restrictive dysfunction, based on the validated and widely used scheme of Redfield et al (JAMA 2003). E/A was used as the primary classification variable. Results: E/A, DT and E/E’ were measurable in 3/4 of pts while PV S/D and A dur were measurable in 1/2 and 1/4 of pts, respectively. The most common reason for inability to record E/A was tachycardia (E/A fusion). Of pts with measurable data, only 55% had ≥3 concordant variables and most of those had normal DF. Summary/Conclusions: Applying the validated DF classification scheme to a wider variety of pts demonstrates: (1) 30% pts could not be classified and (2) only 55% pts have ≥3 concordant measurements. These data suggest the need for a weighted classification scheme which, perhaps, incorporates LA and LV structure, and PA pressure.

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 Pie de riesgo y su estratificación en diabéticos

2017 ◽  
Vol 1 (2) ◽  
pp. 68
Author(s):  
Bárbara Hidalgo Martínez ◽  
Jennifer Alexandra Cabezas Jama ◽  
Edgar Stefano Velásquez Ochoa ◽  
Rasiel Acosta Pérez
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Descriptive Study ◽  
Predisposing Factors ◽  
Peripheral Vascular ◽  
Cross Sectional ◽  
Palabras Clave ◽  
High Prevalence ◽  
El Sistema

El pie diabético es una complicación de la diabetes mellitus (DM) que puede controlarse con el manejo del pie de riesgo (PR). Con el objetivo de determinar la prevalencia de los factores predis- ponentes de esta patología y su estratificación en el paciente diabético, se realizó un estudio des- criptivo transversal, con 824 pacientes que asistieron a la consulta externa de endocrinología del Hospital Humberto Pozo, de febrero a julio de 2016. Para la estratificación, se utilizó el Sistema de Clasificación de Riesgos del Consenso Internacional del pie diabético. Se encontró que el 58,3% de los pacientes, presentó PR, el 30,7% en Grado 1 y 22,4% en Grado 2. Los factores predispo- nentes más frecuentes son la neuropatía (36,7%), la enfermedad vascular periférica (32,1%) y las deformidades ortopédicas (15,7%). Se identificó una elevada prevalencia de PR que permite con un correcto manejo de los factores predisponentes, prevenir lesiones y amputaciones. Palabras clave: Pie de riesgo, pie diabético, amputación, prevención de pie diabético. Abstract Diabetic foot is a complication of diabetes mellitus that can be controlled with the management of the risk foot. In order to determine the prevalence of the predisposing factors of the risk foot and its stratification in the diabetic patient, a cross-sectional descriptive study was conducted with 824 dia- betic patients attending the outpatient clinic of endocrinology Humberto Pozo Hospital in the period from February to July 2016. For the stratification, the International Classification of Risks of the Dia- betic Foot Consensus was used. The most frequent predisposing factors were neuropathy (36.7%), peripheral vascular disease (32.1%) and orthopedic deformities (15.7%). A high prevalence of risk foot was identified that allows, with a correct management of the predisposing factors, to prevent injuries and amputations. Key words: risk foot, diabetic foot, amputation, prevention of diabetic foot.  

scholarly journals Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024144 ◽  
Author(s):  
Lin Zhang ◽  
Xi Zhu ◽  
Xiangmiao Qiu ◽  
Yajiao Li ◽  
Yucheng Chen ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Single Centre ◽  
Cross Sectional ◽  
High Prevalence ◽  
The Right ◽  
Patients With Epilepsy

ObjectivesTo investigate the relationship between right-to-left shunt and migraine to account for the unexplained high prevalence of migraine in patients with epilepsy.DesignThis is a cross-sectional study. The diagnosis and interview process of patients with migraine was based on the International Classification of Headache Disorders-3 beta in patients with epilepsy. Participants underwent transthoracic echocardiography (TTE) with contrast medium to identify right-to-left shunt. The highest number of microbubbles were recorded in the left atrium before the complete microbubble outflow of the right atrium. A moderate-to-large shunt was defined as the presence of 10 or more microbubbles.SettingA single-centre, cross-sectional study in China, 2015–2017.ParticipantsPatients with epilepsy.Primary and secondary outcome measuresThe primary outcome measures were the prevalence of migraine, the prevalence of right-to-left shunt in patients with migraine and those without migraine, and the prevalence of migraine in different degrees of shunting.ResultsThree hundred thirty-nine participants with epilepsy who completed TTE were included in the analysis. The overall prevalence of migraine was 23.0%. One-third of the migraineurs had mild right-to-left shunt and one-fifth of the migraineurs had moderate-to-large right-to-left shunt. Patients with mild shunt did not have a higher prevalence of migraine than those without shunt (26.3% vs 18.1%, p=0.102); however, a higher prevalence of migraine was found in patients with moderate-to-large shunt (39.0% vs 18.1%, OR=2.90, 95% CI=1.41 to 5.98, p=0.003). Patients with migraine and patients without migraine had similar prevalence of mild shunt; however, patients with migraine had more moderate-to-large shunt (20.5% vs 9.6%, p=0.002). Right-to-left shunt and female were factors predicting migraine prevalence.ConclusionsOne-fifth of migraineurs were correlated with moderate-to-large right-to-left shunt which could be an underlying cause of migraine in epilepsy.

scholarly journals Migraine headache in patients with idiopathic intracranial hypertension

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Farzad Sina ◽  
Saeed Razmeh ◽  
Neda Habibzadeh ◽  
Arefeh Zavari ◽  
Mona Nabovvati
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Idiopathic Intracranial Hypertension ◽  
Migraine Headache ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
High Prevalence

Migraine is a neurological disorder that afflicts many people in the world and can cause severe disability during the attacks. The pathophysiology of migraine is complex and not fully understood. It seems that migraine is common in idiopathic intracranial hypertension (IIH). However, the association between migraine headache and IIH is still unclear. The present study was conducted to assess the prevalence of migraine headache and associated factors in IIH patients. In this cross-sectional study, a total of 68 patients diagnosed with IIH underwent a medical history interview and a neurological examination. The diagnosis of migraine was based on the four diagnostic criteria of the International Classification of Headache Disorders 3rd edition. Forty-five patients (63.2%) met the diagnostic criteria of migraine headache. There was no significant difference between patients with and without migraine headache in respect of their age, gender, body mass. This study revealed high prevalence of migraine headache in IIH patients; appropriate treatment can reduce their headache and prevent unnecessary treatments for IIH.

scholarly journals Pie de riesgo y su estratificación en diabéticos

2017 ◽  
Vol 1 (2) ◽  
pp. 68
Author(s):  
Bárbara Hidalgo Martínez ◽  
Jennifer Alexandra Cabezas Jama ◽  
Edgar Stefano Velásquez Ochoa ◽  
Rasiel Acosta Pérez
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Descriptive Study ◽  
Predisposing Factors ◽  
Peripheral Vascular ◽  
Cross Sectional ◽  
Palabras Clave ◽  
High Prevalence ◽  
El Sistema

El pie diabético es una complicación de la diabetes mellitus (DM) que puede controlarse con el manejo del pie de riesgo (PR). Con el objetivo de determinar la prevalencia de los factores predis- ponentes de esta patología y su estratificación en el paciente diabético, se realizó un estudio des- criptivo transversal, con 824 pacientes que asistieron a la consulta externa de endocrinología del Hospital Humberto Pozo, de febrero a julio de 2016. Para la estratificación, se utilizó el Sistema de Clasificación de Riesgos del Consenso Internacional del pie diabético. Se encontró que el 58,3% de los pacientes, presentó PR, el 30,7% en Grado 1 y 22,4% en Grado 2. Los factores predispo- nentes más frecuentes son la neuropatía (36,7%), la enfermedad vascular periférica (32,1%) y las deformidades ortopédicas (15,7%). Se identificó una elevada prevalencia de PR que permite con un correcto manejo de los factores predisponentes, prevenir lesiones y amputaciones. Palabras clave: Pie de riesgo, pie diabético, amputación, prevención de pie diabético. Abstract Diabetic foot is a complication of diabetes mellitus that can be controlled with the management of the risk foot. In order to determine the prevalence of the predisposing factors of the risk foot and its stratification in the diabetic patient, a cross-sectional descriptive study was conducted with 824 dia- betic patients attending the outpatient clinic of endocrinology Humberto Pozo Hospital in the period from February to July 2016. For the stratification, the International Classification of Risks of the Dia- betic Foot Consensus was used. The most frequent predisposing factors were neuropathy (36.7%), peripheral vascular disease (32.1%) and orthopedic deformities (15.7%). A high prevalence of risk foot was identified that allows, with a correct management of the predisposing factors, to prevent injuries and amputations. Key words: risk foot, diabetic foot, amputation, prevention of diabetic foot.  

Estimated Frequency of Psychodermatologic Conditions in Alberta, Canada

2020 ◽  
pp. 120347542095242
Author(s):  
Tarek Turk ◽  
Marlene Dytoc ◽  
Erik Youngson ◽  
Adam Abba-Aji ◽  
Pamela Mathura ◽  
...  
Keyword(s):  
Psychotropic Medication ◽  
Multidisciplinary Approach ◽  
Claims Data ◽  
Psychotropic Medications ◽  
Care Pathways ◽  
Health Issues ◽  
Optimal Care ◽  
International Classification Of Disease ◽  
Psychoactive Medication

Background Psychodermatologic disorders are difficult to identify and treat. Knowledge about the prevalence of these conditions in dermatological practice in Canada is scarce. This hampers our ability to address potential gaps and establish optimal care pathways. Objectives To provide an estimate of the frequencies of psychodermatologic conditions in dermatological practice in Alberta, Canada. Methods Two administrative provincial databases were used to estimate the prevalence of potential psychodermatological conditions in Alberta from 2014 to 2018. Province-wide dermatology claims data were examined to extract relevant International Classification of Disease codes as available. Claims were linked with pharmacy dispensation data to identify patients who received at least 1 psychoactive medication within 90 days of the dermatology claim. Results Of 243 963 patients identified, 28.6% had received at least 1 psychotropic medication (mean age: 47.9 years; 67.5% female). Rates of concurrent psychotropic medications were highest for pruritus and related conditions (46.7%), followed by urticaria (44.5%) and hyperhidrosis (32.8%). Among patients with psychotropic medications, rates of antidepressants were highest (56.3%), followed by anxiolytics (37.1%). Across billing codes, besides hyperhidrosis (71.2%), diseases of hair (61.4%) and psoriasis (59.1%) had the highest rates of antidepressant dispensations. Patients with atopic dermatitis had the highest rates for anxiolytic prescriptions (54.3%). Conclusion In a 5-year window, more than a quarter of the identified dermatology patients in Alberta received at least 1 psychotropic medication, pointing to high rates of potential psychodermatologic conditions and/or concurrent mental health issues in dermatology. Diagnostic and care pathways should include a multidisciplinary approach to better identify and treat these conditions.

scholarly journals Prevalence of Psychiatric Illness among Residents of Old Age Homes in Northern India

2018 ◽  
Vol 09 (02) ◽  
pp. 193-196 ◽  
Author(s):  
Shamsi Akbar ◽  
S. C. Tiwari ◽  
Rakesh K. Tripathi ◽  
Nisha M. Pandey ◽  
Ambrish Kumar
Keyword(s):  
Older Adults ◽  
Old Age ◽  
Psychiatric Illness ◽  
Mental Health Problems ◽  
Cross Sectional ◽  
International Classification Of Disease ◽  
Northern India ◽  
Interview Research ◽  
High Prevalence ◽  
Old Age Homes

ABSTRACT Context: There are many factors which compelled older adults to live in old age homes (OAHs) and vulnerable to psychological problems. Studies reported high prevalence of mental health problems (20%–60%) among elderlies of OAHs. Therefore, the study was conducted to explore prevalence of psychiatric illness (PI) among residents of OAHs of Northern India. Settings and Design: The present study was conducted in OAHs of Districts Bareilly, Lucknow, Varanasi, Dehradun, and Haridwar, using cross-sectional descriptive study method. Sample Size were 306 (male – 98 [32.5%] and female n = 208 [68%]) residing in OAHs selected by means of purposive sampling. Subjects and Methods: Inclusion criteria: (a) older adults aged 60 years and above residing in OAHs and able to communicate. (b) Staying in OAHs for 6 months or more. (c) Able to understand comprehends and reply to questions and (d) Giving written informed consent. Exclusion criteria: (a) Residents who declined/not interested to participate in the study. (b) Residents having any sensory impairment/physical health problem which can impede the interview. Research tools were (i) a semi-structured pro forma, (ii) Hindi Mental Status Examination, (iii) Survey psychiatric assessment schedule, and (iv) Schedules for clinical assessment in neuropsychiatry-based clinical interview for diagnosis of PIs according to International Classification of Disease 10. Statistical Analysis Used: The quantitative data obtained was analyzed by means of frequency tables. Results: The results show overall prevalence of PI is 43% among residents of OAHs. The prevalence of PI was found to be higher among females compared to males. Depression was the most common among the residents of OAHs. Conclusions: There is an urgent need of trained professionals to provide professional help for highly prevalent psychiatric disorders among residents of OAHs.

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