Clinical features, treatment, and outcome of dogs with Coccidioides osteomyelitis

2022 ◽  
pp. 1-8
Author(s):  
Stephanie L. Shaver ◽  
Daniel S. Foy ◽  
Todd D. Carter
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Signs ◽  
Test Results ◽  
Serologic Test ◽  
Rapid Improvement ◽  
Radiographic Appearance ◽  
One Year ◽  
Positive Results

Abstract OBJECTIVE To describe signalment, clinical signs, serologic test results, treatment, and outcome of dogs with Coccidioides osteomyelitis (COM) and to compare those findings with findings for dogs with osteosarcoma (OSA). ANIMALS 14 dogs with COM and 16 dogs with OSA. PROCEDURES Data were retrospectively gathered from electronic medical records. RESULTS Dogs with COM were younger and weighed less than dogs with OSA. Six dogs with COM had appendicular lesions, 5 had axial lesions, and 3 had both appendicular and axial lesions; 9 had monostotic disease, and 5 had polyostotic disease. Axial lesions and nonadjacent polyostotic disease were more common in dogs with COM than in dogs with OSA, but radiographic appearance was not different between the 2 groups. Median IgG titer at diagnosis of COM was 1:48 and was significantly decreased after 6 and 12 months of treatment. Percentage of dogs with COM that had clinical signs was significantly decreased after 1, 3, 6, and 12 months of treatment. One year after initiation of treatment, 9 of 9 dogs were still receiving fluconazole and 8 of 9 dogs had positive results for serum IgG titer testing. CLINICAL RELEVANCE Dogs with COM typically had a rapid improvement in clinical signs after initiating treatment with fluconazole but required long-term antifungal treatment. Dogs with COM differed from dogs with OSA, but radiographic features had a great degree of overlap between groups, confounding the ability to make a diagnosis on the basis of diagnostic imaging alone.

scholarly journals What Results Should Be Returned from Opportunistic Screening in Translational Research?

2020 ◽  
Vol 10 (1) ◽  
pp. 13 ◽  
Author(s):  
Colin M. E. Halverson ◽  
Sarah H. Jones ◽  
Laurie Novak ◽  
Christopher Simpson ◽  
Digna R. Velez Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Primary Care Physicians ◽  
Ethical Issues ◽  
Opportunistic Screening ◽  
Test Results ◽  
Undue Burden ◽  
Positive Results

Increasingly, patients without clinical indications are undergoing genomic tests. The purpose of this study was to assess their appreciation and comprehension of their test results and their clinicians’ reactions. We conducted 675 surveys with participants from the Vanderbilt Electronic Medical Records and Genomics (eMERGE) cohort. We interviewed 36 participants: 19 had received positive results, and 17 were self-identified racial minorities. Eleven clinicians who had patients who had participated in eMERGE were interviewed. A further 21 of these clinicians completed surveys. Participants spontaneously admitted to understanding little or none of the information returned to them from the eMERGE study. However, they simultaneously said that they generally found testing to be “helpful,” even when it did not inform their health care. Primary care physicians expressed discomfort in being asked to interpret the results for their patients and described it as an undue burden. Providing genetic testing to otherwise healthy patients raises a number of ethical issues that warrant serious consideration. Although our participants were enthusiastic about enrolling and receiving their results, they express a limited understanding of what the results mean for their health care. This fact, coupled the clinicians’ concern, urges greater caution when educating and enrolling participants in clinically non-indicated testing.

scholarly journals An Integrated Influenza Surveillance Framework Based on National Influenza-Like Illness Incidence and Multiple Hospital Electronic Medical Records for Early Prediction of Influenza Epidemics: Design and Evaluation (Preprint)

2018 ◽  
Author(s):  
Cheng-Yi Yang ◽  
Ray-Jade Chen ◽  
Wan-Lin Chou ◽  
Yuarn-Jang Lee ◽  
Yu-Sheng Lo
Keyword(s):  
Health Care ◽  
Infectious Diseases ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Predictive Power ◽  
Influenza Surveillance ◽  
Early Prediction ◽  
Influenza Like Illness ◽  
Reporting Systems ◽  
Positive Results

BACKGROUND Influenza is a leading cause of death worldwide and contributes to heavy economic losses to individuals and communities. Therefore, the early prediction of and interventions against influenza epidemics are crucial to reduce mortality and morbidity because of this disease. Similar to other countries, the Taiwan Centers for Disease Control and Prevention (TWCDC) has implemented influenza surveillance and reporting systems, which primarily rely on influenza-like illness (ILI) data reported by health care providers, for the early prediction of influenza epidemics. However, these surveillance and reporting systems show at least a 2-week delay in prediction, indicating the need for improvement. OBJECTIVE We aimed to integrate the TWCDC ILI data with electronic medical records (EMRs) of multiple hospitals in Taiwan. Our ultimate goal was to develop a national influenza trend prediction and reporting tool more accurate and efficient than the current influenza surveillance and reporting systems. METHODS First, the influenza expertise team at Taipei Medical University Health Care System (TMUHcS) identified surveillance variables relevant to the prediction of influenza epidemics. Second, we developed a framework for integrating the EMRs of multiple hospitals with the ILI data from the TWCDC website to proactively provide results of influenza epidemic monitoring to hospital infection control practitioners. Third, using the TWCDC ILI data as the gold standard for influenza reporting, we calculated Pearson correlation coefficients to measure the strength of the linear relationship between TMUHcS EMRs and regional and national TWCDC ILI data for 2 weekly time series datasets. Finally, we used the Moving Epidemic Method analyses to evaluate each surveillance variable for its predictive power for influenza epidemics. RESULTS Using this framework, we collected the EMRs and TWCDC ILI data of the past 3 influenza seasons (October 2014 to September 2017). On the basis of the EMRs of multiple hospitals, 3 surveillance variables, TMUHcS-ILI, TMUHcS-rapid influenza laboratory tests with positive results (RITP), and TMUHcS-influenza medication use (IMU), which reflected patients with ILI, those with positive results from rapid influenza diagnostic tests, and those treated with antiviral drugs, respectively, showed strong correlations with the TWCDC regional and national ILI data (r=.86-.98). The 2 surveillance variables—TMUHcS-RITP and TMUHcS-IMU—showed predictive power for influenza epidemics 3 to 4 weeks before the increase noted in the TWCDC ILI reports. CONCLUSIONS Our framework periodically integrated and compared surveillance data from multiple hospitals and the TWCDC website to maintain a certain prediction quality and proactively provide monitored results. Our results can be extended to other infectious diseases, mitigating the time and effort required for data collection and analysis. Furthermore, this approach may be developed as a cost-effective electronic surveillance tool for the early and accurate prediction of epidemics of influenza and other infectious diseases in densely populated regions and nations.

Collaborative Care Improves Treatment Outcomes for Dogs with Chronic Otitis Externa: A Collaborative Care Coalition Study

2021 ◽  
Vol 57 (5) ◽  
Author(s):  
Dawn Logas ◽  
Elizabeth A. Maxwell
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Medical Records ◽  
Otitis Externa ◽  
Clinical Signs ◽  
Median Number ◽  
Long Term Outcomes ◽  
Treatment History ◽  
Ear Canals

ABSTRACT The purpose of this retrospective study was to compare outcome measures in dogs treated by a primary care veterinarian (pcDVM) before referral and after seeking collaboration with a board-certified veterinary dermatologist (BCVD) for cases of severe recurrent chronic otitis externa. Medical records of 65 client-owned dogs were retrospectively reviewed, and data were obtained regarding treatment history, referral timeframe, recurrence rate, clinical signs, and resolution of signs. The median number of otitis recurrences while under the care of the pcDVM was 4 (range 1–40) versus collaborative BCVD care of 2 (P < .01). There was a longer median time to otitis recurrence with collaborative care (171 days) compared with dogs managed by the pcDVM before referral (21 days; P > .01). Proliferative changes in the ear canals improved in 41/45 (91%) of cases under BCVD care compared with 6/45 (13%) under care by the pcDVM (P < .01). Dogs with chronic otitis had better long-term outcomes when collaboration with a BCVD was pursued within 6 mo of treatment. Referral or consultation with a BCVD should be considered for cases of chronic canine otitis that are persistent or quickly recurrent (20–30 days) over a 6 mo period.

Transformer + GAN based Traditional Chinese Medicine inpatient prescription recommendation (Preprint)

2021 ◽  
Author(s):  
Hong Zhang
Keyword(s):  
Decision Making ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Electronic Medical Records ◽  
Clinical Diagnosis ◽  
Medical Records ◽  
Training Data ◽  
Diagnosis And Treatment ◽  
Test Results ◽  
Treatment Scheme

BACKGROUND Clinical diagnosis and treatment decision making support is at the core of medical artificial intelligent research, in which Traditional Chinese Medicine (TCM) decision making is an important part. Traditional Chinese Medicine is a traditional medical system originated from China, of which the main clinical model is to conduct individualized diagnosis and treatment by relying on the four-diagnosis information. One of the key tasks of the TCM artificial intelligence research is to develop techniques and methods of clinical prescription decision making which takes all the relevant information of a patient as input, and produces a diagnosis and treatment scheme as output. Given the complexity of TCM clinical diagnosis and treatment schemes, decision making support of clinical diagnosis and treatment schemes remains as a research challenge for lacking of an effective solution. Fortunately, as the volume of the massive clinical data in the form of electronic medical records increases rapidly, it becomes possible for the computer to produce personalized diagnosis and treatment scheme recommendation through machine learning on the basis of the clinical big data. OBJECTIVE The objective of this research is to develop a real-time diagnosis and treatment scheme recommendation model for TCM inpatients. This is accomplished by using historical clinical medical records as training data to train a Transformer network. Furthermore, to alleviate the issue of overfitting, a Generative Adversarial Network is used to generate noise-added samples from the original training data. These noise-added samples along with the original samples form the complete train data set. METHODS valid information, such as the patient’s current sickness situation, medicines taken, nursing care given, vital signs, examinations and test results, is extracted from the patient’s electronic medical records, then the obtained information is sorted chronically, to produce a sequence of data of each patient. These time-sequence data is then used as input to the Transformer network. The output of the network would be the prescription information a physician would give. Overfitting is a common problem in machine learning, and becomes especially server when the network is complex with insufficient training data. In this research, a Generative Adversarial Network, is used to double the number of training samples by producing noise-added samples from the original samples. This, to a great extent, lessens the overfitting problem. RESULTS A total of 21,295 copies of inpatient electronic medical records from Guang’anmen traditional Chinese medicine hospital was used in this research. These records were created between January 2017 and December 2018, covering a total of 6352 kinds of medicines. These medicines were sorted into 829 types of first category medicines based on the class relationships among medicines. As shown by the test results, the performance of a fully trained Transformer model can have an average precision rate of 80.58%，and an average recall rate of 68.49%. CONCLUSIONS As shown by the preliminary test results, the Transformer-based TCM prescription recommendation model outperforms the existing conventional methods. The extra training samples generated by the GAN network helps to overcome the overfitting issue, leading a further improved recall rate and precision rate.

Extrahepatic biliary tract obstruction: a retrospective study of 45 cases (1983-1993)

1995 ◽  
Vol 31 (6) ◽  
pp. 478-482 ◽  
Author(s):  
MA Fahie ◽  
RA Martin
Keyword(s):  
Biliary Tract ◽  
Medical Records ◽  
Serum Bilirubin ◽  
Necrotizing Pancreatitis ◽  
Elevated Serum ◽  
Clinical Signs ◽  
Pathological Process ◽  
Biliary Tract Surgery ◽  
Long Term Prognosis

The medical records of 41 dogs and four cats with either surgical or postmortem confirmation of extrahepatic biliary tract obstruction were reviewed. Clinical signs of icterus, vomiting, anorexia, or a combination of these signs were exhibited by 100% of cases. Elevated serum bilirubin was documented in 37 of 41 dogs and two of four cats (86.6%). The predominant, underlying, pathological process was extraluminal obstruction of the biliary tract due to pancreatitis (19 of 45 cases; 42.2%) or neoplasia (11 of 45 cases; 24.4%). Biliary tract surgery was performed in 29 cases, of which 12 (41.3%) recovered. Animals diagnosed with extrahepatic biliary tract obstruction had a relatively good long-term prognosis, provided they were not compromised substantially due to severe necrotizing pancreatitis or neoplasia.

Are We Doing Too Many HIT Tests?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1240-1240
Author(s):  
Muralidhar Reddy Yerramadha ◽  
Aakash Desai ◽  
Subramanian Seshan
Keyword(s):  
Venous Thromboembolism ◽  
Medical Records ◽  
Pretest Probability ◽  
Cardiac Care ◽  
Type Ii ◽  
Test Results ◽  
Elisa Testing ◽  
Low Probability ◽  
One Year ◽  
Cardiac Care Unit

Abstract Abstract 1240 Background: Heparin-induced thrombocytopenia (type II-HIT) is a serious immune mediated clinicopathologic syndrome that may lead to significant arterial or venous thromboembolism and moderate to severe thrombocytopenia. Type II-HIT is estimated to occur with a frequency of 0.2 to 5.0 % after exposure to heparin. Objective: To determine the incidence of type II-HIT and the necessity of its testing within a single, 450-bed, urban, teaching, community hospital. Methods: A retrospective review of the hospital database of inpatient and laboratory medical records was performed for a one-year period from July 2009 to July 2010. Medical records were reviewed to determine how many patients were tested for HIT (i.e., solid phase immunoassay or H-PF4-ELISA) - with the test results and how many confirmatory Serotonin Release Assays (SRA) were performed and the test results. Data was categorized into subgroups depending on the type of care, diagnosis, type of heparin and the dosage of heparin. The percentage of SRA positivity for different strengths of H-PF4-ELISA positivity was also investigated with optical density (OD) at 405 nm (weakly positive with O.D 0.4–0.99, intermediately positive with O.D. 1–1.99 and strongly positive if O.D. equal or more than 2). Pretest probability was also calculated by using 4T's score for all patients with positive ELISA. Results: A total of 19,474 patient admissions occurred over the one year period. An estimated 213 patients had H-PF4-ELISA tests done. Overall H-PF4-ELISA testing incidence was 1% (213 out of 19,474), overall incidence of H-PF4-ELISA positivity out of all admissions during that year was 0.2% (42 out if 19,474). In this study higher frequency of HIT (H-PF4 ELISA) testing was observed in patients who were treated in ICU and cardiac care unit as well as patients treated for sepsis and venous thromboembolism (VTE). The most common type of heparin associated with higher rate of HIT testing was unfractionated heparin-UFH (prophylactic dose more than therapeutic dose) as compared to low molecular weight heparin-LMWH. The incidence of ELISA test positivity was greatest among patients in the ICU and cardiac care unit and patients with sepsis and VTE. Higher incidence of ELISA positivity was associated with UFH. Out of all performed HIT tests ELISA positivity was 19.71% (42 out of 213) and 171 ELISA tests were negative. 36 of the positive ELISA tests were weakly positive, indicating very low probability of HIT. Out of 42 positive ELISA tests 50% (total 21 of 42) had SRA and none of the SRA returned positive. For all 42 patients with positive ELISA tests, the pretest probability was calculated using the 4T score. These show that of the 42 positive ELISA tests, 52.38% (22 of 42) had a low probability, 28.57 (12 of 42) had an intermediate probability, and only 11.9% (5 of 42) had a high probability. Conclusions: From this study, we conclude that in our institute we are doing too many HIT studies. To avoid unnecessary testing and improve cost effectiveness, this study emphasizes the importance of considering clinical situation and pretest probability very carefully, prior to testing. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Balloon dilation for the treatment of nasopharyngeal stenosis in seven cats

2017 ◽  
Vol 3 (2) ◽  
pp. 205511691772998
Author(s):  
Stefeny Z Pollack ◽  
Peter S Chapman ◽  
Alan Klag
Keyword(s):  
Effective Treatment ◽  
Medical Records ◽  
Balloon Dilation ◽  
Clinical Signs ◽  
Upper Airway ◽  
Short Term ◽  
Effective Treatment Option ◽  
Endoscopic Guidance ◽  
Ocular Discharge

Objectives The objective of this study was to evaluate the effectiveness of balloon dilation for the treatment of nasopharyngeal stenosis in cats. Methods The medical records of seven cats with nasopharyngeal stenosis treated with balloon dilation were reviewed. The most common presenting clinical signs included upper airway noise, sneezing, nasal and/or ocular discharge. All seven cats were confirmed to have nasopharyngeal stenosis via nasopharyngeal endoscopy and were treated with balloon dilation under endoscopic guidance. Results All seven cats had acceptable short-term control (median 14 days) of clinical signs after the procedure. Two of six cats had successful long-term control (median 34 days) of clinical signs after one balloon dilation and an additional 2/6 cats had acceptable long-term control of clinical signs after a second balloon dilation procedure. The most significant complication of balloon dilation was the recurrence of stenosis. Conclusions and relevance The findings of this study indicate that balloon dilation is a safe and effective treatment option for the relief of clinical signs associated with nasopharyngeal stenosis in cats. Multiple procedures may be necessary for the best chance of long-term success.

scholarly journals An Assessment of Globe Position Dynamics following Transcranial Lateral and Superior Orbital Wall Resections without Rigid Reconstruction: A Case Series of 55 Patients

2019 ◽  
Vol 81 (03) ◽  
pp. 244-250
Author(s):  
Randall G. Krug ◽  
Elizabeth A. Bradley ◽  
Jamie J. Van Gompel
Keyword(s):  
Skull Base ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Significant Risk ◽  
Case Series ◽  
Time Points ◽  
Orbital Wall ◽  
Skull Base Approach ◽  
Over Time

Background There is no consensus exists regarding which reconstructive approach, if any, should be used after performing transcranial lateral orbital wall resections. Rigid reconstruction is often done to prevent enophthalmos; however, it is not clear if this is a risk with extensive orbital wall resections for transcranial surgery. Objective To assess globe position dynamics in patients that underwent transcranial lateral and superior orbital wall resections without rigid reconstruction to determine if enophthalmos is a significant risk. Methods Preoperative (PO) and postoperative data were retrospectively collected from the electronic medical records of 55 adult patients undergoing lateral and superior orbital wall resections as part of a skull base approach. The globe positions were assessed radiologically at all available time points and used to track relative globe displacements over time. Results An evaluation of PO variables identified a relationship between maximum lesion diameters and globe positions dynamics. The composition of globe position presentations in the population remained relatively stable over time, with only 1 out of 55 patients (1.81%) developing postoperative enophthalmos. An assessment of mean globe displacements revealed improvements in the patients presenting with PO exophthalmos, and stability in the patients presenting with normal PO globe positions. Conclusions Excellent results in long-term postoperative globe position dynamics can be achieved without the use of rigid reconstruction after transcranial lateral and superior orbital wall resections, regardless of the PO globe positioning.

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