Assessment of memory complainers in São Paulo, Brazil: Three-year results of a memory clinic

Abstract Memory clinics were established in the USA and European countries as services to attend patients who complain of cognitive deficits, referred by primary care doctors, specialists and other hospitals. Objective: We aimed to describe the clinical and cognitive profile of consecutively evaluated subjects during the initial three years of service of a memory clinic from a university hospital. Methods: Subjects were submitted to a clinical work-up for dementia, which included laboratory exams, cranial computerized tomography, cognitive tests, and a comprehensive neuropsychological battery. Diagnosis was made according to ICD-10 criteria. Results: We evaluated 104 subjects (67.3% females and 32.7% males), with mean age of 59.1 years, 88.8% aged 50 years or above. Mean schooling was 9.9 years. Patients were classified into 10 different primary diagnostic categories, namely Depression (26.9%), Alzheimer's disease (17.3%), Memory complaints without objective impairment (17.3%), Mild Cognitive Disorder - MCD (14.4%), and Anxiety (12.5%) the most frequent diagnosis. Comparing patients with dementia, MCD, Depression or Anxiety and Memory complainers, by age (below and above 60 years), dementia was more commonly diagnosed in older subjects, while a higher frequency of memory complainers was found in the younger group. Conclusions: This preliminary report from an outpatient group of referred patients with cognitive complaints showed a higher frequency of psychiatric disorders in this sample. The memory clinic approach should be considered as a model of service which can evaluate subjects with cognitive complaints effectively and improve the quality of care delivered to this patient group.

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Prevalence and association of syphilis reactivity in an Asian memory clinic population

International Journal of STD & AIDS ◽

10.1177/0956462418787627 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1368-1374

Author(s):

Bibek Gyanwali ◽

Muhammad A Shaik ◽

Saima Hilal ◽

Jemellee Cano ◽

Christopher Chen ◽

...

Keyword(s):

Logistic Regression ◽

Binary Logistic Regression ◽

University Hospital ◽

Memory Clinic ◽

Community Based ◽

Logistic Regression Models ◽

Gender Education ◽

National University ◽

Memory Clinics ◽

Clinic Population

Data on the association between syphilis reactivity and dementia in memory clinic patients are scarce. We studied the prevalence of syphilis reactivity and investigated its association with dementia and markers of cerebrovascular disease (CeVD) and neurodegeneration. Data on age, gender, education, brain computed tomography scan findings and syphilis reactivity were obtained from patients who attended the National University Hospital memory clinics (February 2006–February 2016) and subjects from the community. Binary logistic regression models were used to investigate associations between syphilis reactivity and dementia, CeVD and neurodegeneration, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Of 1271 memory clinic patients eligible for the study, 57 (4.5%) were syphilis reactive, with the rate of syphilis reactivity higher in demented (44/745; 5.9%) compared to non-demented (13/526; 2.5%) patients ( p = 0.004) and non-demented community-based (21/872; 2.4%) subjects ( p < 0.001). Binary logistic regression showed a significant association between syphilis reactivity and dementia in memory clinic patients independent of demographic factors (odds ratio: 2.06; 95% CI: 1.02–4.17, p = 0.044). A significant association between syphilis reactivity and dementia was found in memory clinic patients. The mechanism of this association requires further research and may involve neuroinflammation.

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A Memory Clinic at a Geriatric Hospital: A Report on 577 Patients Assessed with the CAMDEX Over 9 Years

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2003.01174.x ◽

2003 ◽

Vol 37 (3) ◽

pp. 319-326 ◽

Cited By ~ 29

Author(s):

Joe A. Stratford ◽

Dina Logiudice ◽

Leon Flicker ◽

Roslyn Cook ◽

Wendy Waltrowicz ◽

...

Keyword(s):

Psychiatric Disorders ◽

The Elderly ◽

International Classification Of Diseases ◽

Screening Tools ◽

Cognitive Screening ◽

Memory Clinic ◽

Mental Test Score ◽

Patient Demographics ◽

Significant Difference ◽

Icd 10

Objective: To report 9 years’ experience of an Australian memory clinic using the Cambridge Mental Disorders in the Elderly Examination (CAMDEX) assessment schedule, summarizing patient demographics, diagnoses at presentation and the utility of four instruments used in distinguishing patients with and without dementia. Methods: All patients seen at the clinic between December 1989 and September 1998 were assessed using the CAMDEX. Diagnoses were determined according to criteria of the International Classification of Diseases, tenth edition (ICD-10). Results: The mean age of 577 patients seen was 72.9 years and 60.8% were female. Over 40% fulfilled ICD-10 diagnostic criteria for dementia in Alzheimer's disease. A further 24% had another dementing illness. Only 28 patients were ‘normal’. There was no significant difference in the ability of the 107-item Cambridge cognitive examination, the 30-item mini-mental state examination, the 10-item abbreviated mental test score and the 26-item informant questionnaire on cognitive decline in the elderly to differentiate dementia patients from those who were normal or had functional psychiatric disorders. The four cognitive screening tools had high correlations with one another (r = −0.57 to 0.93). Conclusion: Patient demographics and diagnoses were similar to those found in other clinics. Most people who attended the memory clinic had significant cognitive or psychiatric disorders.

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Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Journal of Clinical Medicine ◽

10.3390/jcm8030345 ◽

2019 ◽

Vol 8 (3) ◽

pp. 345 ◽

Cited By ~ 5

Author(s):

Tobias Kuster ◽

Christian Nickel ◽

Mirjam Jenny ◽

Lana Blaschke ◽

Roland Bingisser

Keyword(s):

Time Course ◽

Predictive Power ◽

Secondary Analysis ◽

Clinical Work ◽

Adverse Outcomes ◽

University Hospital ◽

Chief Complaints ◽

The University ◽

Work Up ◽

Inclusion Period

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

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Interrupted time Series Design to Evaluate ICD-9-CM to ICD-10-CM Coding Changes on Trends in Colorado Emergency Department visits Related to Traumatic Brain Injury

10.21203/rs.3.rs-134764/v1 ◽

2020 ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

P Value ◽

Icd 10 ◽

The Usa ◽

Definition Of

Abstract Background. The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the USA led public health professionals to propose a surveillance definition of traumatic brain injury (TBI) that uses ICD-10-CM codes. The proposed definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI definition. The purpose of this study was to evaluate this change in surveillance methods on monthly rates of TBI-related emergency department visits in Colorado from 2012 to 2017.Results. The monthly rate of TBI-related emergency department visits in the transition month to ICD-10-CM (October 2015) decreased 41 visits per 100,000 population (p-value <0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. Conclusion. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates over time. The findings inform estimation of TBI magnitude based on ICD coded data and decisions about allocating TBI resources based on an estimated TBI magnitude.

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Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study

International Journal of Medical Students ◽

10.5195/ijms.2021.884 ◽

2021 ◽

Vol 9 (3) ◽

pp. 213-218

Author(s):

Patricio Garcia-Espinosa ◽

Edgar Botello-Hernández ◽

Gabriela Torres-Hernández ◽

Clarissa Guerrero-Cavazos ◽

Estefania Villareal-Garza ◽

...

Keyword(s):

Retrospective Study ◽

Univariate Analysis ◽

International Classification Of Diseases ◽

University Hospital ◽

P Value ◽

Predictors Of Mortality ◽

The Hours ◽

Classification Of Diseases ◽

Icd 10 ◽

History Of

Background: Arteriovenous Malformations (AVMs) are abnormalities in intracranial vessels between the arterial and venous systems. This study aimed to identify the predictors of mortality in patients that presented to our hospital with AVMs, ruptured or unruptured, and correlate them to those available in the literature. Methods: An analytical, observational, retrospective study was performed to review data of patients with cerebral AVMs in the University Hospital “Dr José Eleuterio González” from January 2016 to December 2020. Clinical files were reviewed based on AVMs diagnosis according to the International Classification of Diseases 10th Revision, ICD-10. Variables were subjected to a univariate analysis and those found significant (p-value < 0.05) were subjected to a logistic regression. Results: A total of 80 patients were included in our study. Most of the participants were females (56.3%) and three were pregnant. The most common presenting symptom was holocranial headache (34 cases) occurring between the hours of 22:00 to 7:00. The most significant predictors of mortality were a total bleeding volume greater than 9.18 cm3 (p = 0.010), the presence of more than one symptom (p = 0.041), and a history of previous cerebral intraparenchymal hemorrhage (p = 0.014). Conclusion: Results demonstrated an important association between intracranial bleeding and mortality. Ultimately, more prospective studies are needed to determine predictor factors for mortality in AVMs patients.

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Automatic ICD-10 Coding and Training System: Deep Neural Network Based on Supervised Learning

JMIR Medical Informatics ◽

10.2196/23230 ◽

2021 ◽

Vol 9 (8) ◽

pp. e23230

Author(s):

Pei-Fu Chen ◽

Ssu-Ming Wang ◽

Wei-Chih Liao ◽

Lu-Cheng Kuo ◽

Kuan-Chih Chen ◽

...

Keyword(s):

Neural Network ◽

Deep Learning ◽

Natural Language Processing ◽

Natural Language ◽

Language Processing ◽

Deep Neural Network ◽

University Hospital ◽

Classification Model ◽

Icd 10 ◽

And Training

Background The International Classification of Diseases (ICD) code is widely used as the reference in medical system and billing purposes. However, classifying diseases into ICD codes still mainly relies on humans reading a large amount of written material as the basis for coding. Coding is both laborious and time-consuming. Since the conversion of ICD-9 to ICD-10, the coding task became much more complicated, and deep learning– and natural language processing–related approaches have been studied to assist disease coders. Objective This paper aims at constructing a deep learning model for ICD-10 coding, where the model is meant to automatically determine the corresponding diagnosis and procedure codes based solely on free-text medical notes to improve accuracy and reduce human effort. Methods We used diagnosis records of the National Taiwan University Hospital as resources and apply natural language processing techniques, including global vectors, word to vectors, embeddings from language models, bidirectional encoder representations from transformers, and single head attention recurrent neural network, on the deep neural network architecture to implement ICD-10 auto-coding. Besides, we introduced the attention mechanism into the classification model to extract the keywords from diagnoses and visualize the coding reference for training freshmen in ICD-10. Sixty discharge notes were randomly selected to examine the change in the F1-score and the coding time by coders before and after using our model. Results In experiments on the medical data set of National Taiwan University Hospital, our prediction results revealed F1-scores of 0.715 and 0.618 for the ICD-10 Clinical Modification code and Procedure Coding System code, respectively, with a bidirectional encoder representations from transformers embedding approach in the Gated Recurrent Unit classification model. The well-trained models were applied on the ICD-10 web service for coding and training to ICD-10 users. With this service, coders can code with the F1-score significantly increased from a median of 0.832 to 0.922 (P<.05), but not in a reduced interval. Conclusions The proposed model significantly improved the F1-score but did not decrease the time consumed in coding by disease coders.

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Towards Implementation of OMOP in a German University Hospital Consortium

Applied Clinical Informatics ◽

10.1055/s-0037-1617452 ◽

2018 ◽

Vol 09 (01) ◽

pp. 054-061 ◽

Cited By ~ 9

Author(s):

C. Maier ◽

L. Lang ◽

H. Storf ◽

P. Vormstein ◽

R. Bieber ◽

...

Keyword(s):

Data Integration ◽

Large Data ◽

University Hospital ◽

Common Data Model ◽

Ministry Of Education ◽

University Hospitals ◽

Core Element ◽

Icd 10 ◽

Pilot Implementation ◽

Colorectal Cancer Patients

Background In 2015, the German Federal Ministry of Education and Research initiated a large data integration and data sharing research initiative to improve the reuse of data from patient care and translational research. The Observational Medical Outcomes Partnership (OMOP) common data model and the Observational Health Data Sciences and Informatics (OHDSI) tools could be used as a core element in this initiative for harmonizing the terminologies used as well as facilitating the federation of research analyses across institutions. Objective To realize an OMOP/OHDSI-based pilot implementation within a consortium of eight German university hospitals, evaluate the applicability to support data harmonization and sharing among them, and identify potential enhancement requirements. Methods The vocabularies and terminological mapping required for importing the fact data were prepared, and the process for importing the data from the source files was designed. For eight German university hospitals, a virtual machine preconfigured with the OMOP database and the OHDSI tools as well as the jobs to import the data and conduct the analysis was provided. Last, a federated/distributed query to test the approach was executed. Results While the mapping of ICD-10 German Modification succeeded with a rate of 98.8% of all terms for diagnoses, the procedures could not be mapped and hence an extension to the OMOP standard terminologies had to be made.Overall, the data of 3 million inpatients with approximately 26 million conditions, 21 million procedures, and 23 million observations have been imported.A federated query to identify a cohort of colorectal cancer patients was successfully executed and yielded 16,701 patient cases visualized in a Sunburst plot. Conclusion OMOP/OHDSI is a viable open source solution for data integration in a German research consortium. Once the terminology problems can be solved, researchers can build on an active community for further development.

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A survey of memory clinic practice in Scotland

Psychiatric Bulletin ◽

10.1192/pb.bp.107.018614 ◽

2008 ◽

Vol 32 (12) ◽

pp. 467-469 ◽

Cited By ~ 5

Author(s):

Jane Foy

Keyword(s):

Memory Clinic ◽

National Guidelines ◽

Common Component ◽

Prescribing Practice ◽

Memory Clinics ◽

Assessment Techniques ◽

Old Age Psychiatry ◽

Clinical Autonomy ◽

Clinic Practice ◽

The Cost

Aims and MethodA questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.ResultsMemory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.Clinical ImplicationsThere is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

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Subjective cognitive decline, anxiety symptoms, and the risk of mild cognitive impairment and dementia

Alzheimer s Research & Therapy ◽

10.1186/s13195-020-00673-8 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Tau Ming Liew

Keyword(s):

Cognitive Decline ◽

Cox Regression ◽

Cognitive Disorder ◽

Neurocognitive Disorders ◽

Anxiety Symptoms ◽

Sensitivity Analyses ◽

Subjective Cognitive Decline ◽

The Usa ◽

High Risk Populations

Abstract Background Subjective cognitive decline (SCD) and anxiety symptoms both predict neurocognitive disorders, but the two correlate strongly with each other. It is unclear whether they reflect two independent disease processes in the development of neurocognitive disorders and hence deserve separate attention. This cohort study examined whether SCD and anxiety symptoms demonstrate independent risks of mild cognitive disorder and dementia (MCI/dementia). Methods The study included 14,066 participants aged ≥ 50 years and diagnosed with normal cognition at baseline, recruited from Alzheimer’s Disease Centers across the USA. The participants were evaluated for SCD and anxiety symptoms at baseline and followed up almost annually for incident MCI/dementia (median follow-up 4.5 years; interquartile range 2.2–7.7 years). SCD and anxiety symptoms were included in Cox regression to investigate their independent risks of MCI/dementia. Results SCD and anxiety symptoms demonstrated independent risks of MCI/dementia, with HR 1.9 (95% CI 1.7–2.1) and 1.3 (95% CI 1.2–1.5), respectively. Co-occurring SCD and anxiety symptoms demonstrated the highest risk (HR 2.4, 95% CI 1.9–2.9)—participants in this group had a 25% probability of developing MCI/dementia by 3.1 years (95% 2.4–3.7), compared to 8.2 years among those without SCD or anxiety (95% CI 7.9–8.6). The results remained robust even in the sensitivity analyses that took into account symptom severity and consistency of symptoms in the first 2 annual visits. Conclusions The findings suggest that clinicians should not dismiss one over the other when patients present with both SCD and anxiety and that both constructs may potentially be useful to identify high-risk populations for preventive interventions and trials. The findings also point to the need for further research to clarify on the neurobiological distinctions between SCD and anxiety symptoms, which may potentially enrich our understanding on the pathogenesis of neurocognitive disorders.

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Introduction and evaluation of the ACS BCon basic course in Zaragoza, Spain

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000227 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000227

Author(s):

Carlos Yanez ◽

Antonio Güemes ◽

Ana Navarro ◽

Jacqueline Vazquez ◽

Alberto Moreno

Keyword(s):

Medical Students ◽

University Hospital ◽

Hemorrhage Control ◽

Level Of Evidence ◽

Significance Level ◽

American College Of Surgeons ◽

The Usa ◽

Basic Course ◽

The University ◽

Healthcare Employees

BackgroundThe American College of Surgeons Bleeding Control Basic (BCon) course aimed at teaching hemorrhage control techniques in the USA had not yet been taught in Spain. The purpose of this study is to assess its implementation among students and healthcare employees in the Lozano Blesa University Hospital of Zaragoza, a middle-sized Spanish city.MethodsThe study was conducted in a University Hospital and at the University of Zaragoza, scheduling four free B-Con sessions from 2017 to 2018. Two groups were identified as forming the population: healthcare employees and medical students. An anonymous questionnaire was completed at the end of the course regarding content, applicability, usefulness, relevance, and satisfaction. Study variables were ranked from 0 to 10: poor (when graded from 0 to 3), fair (4 to 6) and good (7 to 10). Results were compared between the groups, expressed in percentages and χ2 tested to analyze significant differences if any.ResultsAmong the 83 individuals who completed the course, 46 were medical students and 37 healthcare employees; 61% women and 39% men; aged 21 years to 52 years. Attendees evaluated satisfaction with the highest grade (84%), followed by usefulness (73%), applicability (70%), and relevance (66%). There was no variable graded as poor. The comparison of perceptions between groups did not reveal statistical differences based on a 0.05 significance level.ConclusionWe concluded that the B-Con course was valued as good for relevance, usefulness, applicability, and satisfaction by the majority of the studied population.Level of evidenceLevel III.

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