Clinical Features of Patients With Progressive Supranuclear Palsy in an US Insurance Claims Database

Background: Progressive supranuclear palsy is a rare neurodegenerative movement disorder and little is known about its epidemiology.Objective: Estimate age-adjusted prevalence of progressive supranuclear palsy and describe antecedent diagnoses and progressive supranuclear palsy patient features in the 5 years before first diagnostic code.Methods: In a nested case-control study in the IBM MarketScan Commercial and Medicare Supplemental Databases, a large set of US insurance databases containing medical service and prescription drug claims from employer-based commercial and Medicare supplemental health insurance plans, progressive supranuclear palsy cases (identified via International Statistical Classification of Diseases 9th/10th revision codes) and controls were included if enrollment was ≥1 month in the study period (October 1, 2015–October 31, 2017). Two controls with no diagnosis codes for PSP were matched to cases on birth year, sex, enrollment time in the database, and pharmacy benefit eligibility. Controls were assigned a randomly selected index date from their eligibility period. Prevalence of progressive supranuclear palsy was estimated in 2016 among patients with ≥1 month of continuous enrollment in that year. Prevalence ratios for comorbidities (claim/diagnosis codes) were examined in the ≤ 5 years before index date (first progressive supranuclear palsy claim date).Results: Age-adjusted progressive supranuclear palsy prevalence was 2.95/100,000 in 2016. The most common diagnosis codes in cases vs. controls in the 5 years pre-index were gait abnormalities (79.3 vs. 21.8%), pain in joint (54.9 vs. 36.0%), Parkinson's disease (54.6 vs. 1.0%), fatigue (49.8 vs. 21.6%), and cerebrovascular disease (45.6 vs. 16.4%).Conclusions: In this large database analysis, based on preliminary analyses, the prevalence of diagnosed progressive supranuclear palsy was 2.95/100,000, which is lower than many prior studies. Typical symptoms suggestive of progressive supranuclear palsy were present before index date, indicating a potential delay in time to diagnosis. The identification of diagnostic codes for clinical features of progressive supranuclear palsy that occurred before index date may be used to develop predictive models to identify potential progressive supranuclear palsy patients earlier in their disease course.

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Diagnostic code agreement for electronic health records and claims data for tuberculosis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0792 ◽

2020 ◽

Vol 24 (7) ◽

pp. 706-711

Author(s):

S. A. Iqbal ◽

C. J. Isenhour ◽

G. Mazurek ◽

B. I. Truman

Keyword(s):

Electronic Health Records ◽

Latent Tuberculosis ◽

Population Based ◽

Positive Tuberculin Skin Test ◽

Diagnostic Code ◽

Snomed Ct ◽

Health Records ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Electronic Health

OBJECTIVE: To measure the frequency of diseases related to latent tuberculosis infection (LTBI) and tuberculosis (TB), we assessed the agreement between diagnosis codes for TB or LTBI in electronic health records (EHRs) and insurance claims for the same person.METHODS: In a US population-based, retrospective cohort study, we matched TB-related Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) EHR codes and International Statistical Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) claims codes. Furthermore, LTBI was identified using a published ICD-based algorithm and all LTBI- and TB-related SNOMED CT codes.RESULTS: Of people with the 10 most frequent TB-related claim codes, 50% did not have an exact-matched EHR code. Positive tuberculin skin test was the most frequent unmatched EHR code and people with the 10 most frequent TB EHR codes, 40% did not have an exact-matched claim code. The most frequent unmatched claim code was TB screening encounter. EHR codes for LTBI matched to claims codes for TB testing; pulmonary TB; and nonspecific, positive or adverse tuberculin reaction.CONCLUSION: TB-related EHR codes and claims diagnostic codes often disagree, and people with claims codes for LTBI have unexpected EHR codes, indicating the need to reconcile these coding systems.

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A Deep Learning Framework for Automated ICD-10 Coding

Studies in Health Technology and Informatics - Public Health and Informatics ◽

10.3233/shti210178 ◽

2021 ◽

Author(s):

Abdelahad Chraibi ◽

David Delerue ◽

Julien Taillard ◽

Ismat Chaib Draa ◽

Régis Beuscart ◽

...

Keyword(s):

Deep Learning ◽

Language Processing ◽

Medical Information ◽

Coding System ◽

Learning Framework ◽

Diagnosis Codes ◽

Automated Coding ◽

Classification Of Diseases ◽

Icd 10 ◽

International Statistical Classification

The International Statistical Classification of Diseases and Related Health Problems (ICD) is one of the widely used classification system for diagnoses and procedures to assign diagnosis codes to Electronic Health Record (EHR) associated with a patient’s stay. The aim of this paper is to propose an automated coding system to assist physicians in the assignment of ICD codes to EHR. For this purpose, we created a pipeline of Natural Language Processing (NLP) and Deep Learning (DL) models able to extract the useful information from French medical texts and to perform classification. After the evaluation phase, our approach was able to predict 346 diagnosis codes from heterogeneous medical units with an accuracy average of 83%. Our results were finally validated by physicians of the Medical Information Department (MID) in charge of coding hospital stays.

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A Dermatologia na Enfermaria de Medicina Interna: Análise Retrospectiva de um Centro Terciário

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.78.1.1099 ◽

2020 ◽

Vol 78 (1) ◽

pp. 37-40

Author(s):

Tomás Pessoa e Costa ◽

Ana Luísa João ◽

Márcia Pereira ◽

Ana Rita Estriga ◽

Filipa Rocha Páris ◽

...

Keyword(s):

Internal Medicine ◽

Skin Diseases ◽

Statistical Classification ◽

Common Diagnosis ◽

Classification Of Diseases ◽

International Statistical Classification ◽

Internal Medicine Wards ◽

The Impact ◽

De Medicina

Background: Skin diseases are common in Internal Medicine wards and often require observation by a dermatologist. This study intends to characterize the pattern of skin pathology in these patients and to evaluate the impact of dermatologists in their approach. Methods: A retrospective study was conducted. Dermatology observations over 46 months in Internal Medicine wards of Hospital Santo António dos Capuchos were analyzed. Patients’ conditions were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Results: 231 men and 217 women were observed, with an average age of 72.6 years. Stasis dermatitis and venous leg ulcers were the most common diagnosis. Discussion and Conclusion: The Dermatology team significantly reduced the number of undiagnosed patients. Our study reinforces the importance of dermatologists in the evaluation of inpatients with skin diseases.

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Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000673 ◽

2020 ◽

Vol 48 (1) ◽

pp. 3-14 ◽

Cited By ~ 3

Author(s):

Carolin Szász-Janocha ◽

Eva Vonderlin ◽

Katajun Lindenberg

Keyword(s):

Internet Use ◽

Health Problems ◽

Reliable Change Index ◽

Gaming Disorder ◽

Statistical Classification ◽

Reliable Change ◽

Classification Of Diseases ◽

International Statistical Classification

Zusammenfassung. Fragestellung: Das junge Störungsbild der Computerspiel- und Internetabhängigkeit hat in den vergangenen Jahren in der Forschung zunehmend an Aufmerksamkeit gewonnen. Durch die Aufnahme der „Gaming Disorder“ in die ICD-11 (International Statistical Classification of Diseases and Related Health Problems) wurde die Notwendigkeit von evidenzbasierten und wirksamen Interventionen avanciert. PROTECT+ ist ein kognitiv-verhaltenstherapeutisches Gruppentherapieprogramm für Jugendliche mit Symptomen der Computerspiel- und Internetabhängigkeit. Die vorliegende Studie zielt auf die Evaluation der mittelfristigen Effekte nach 4 Monaten ab. Methodik: N = 54 Patientinnen und Patienten im Alter von 9 bis 19 Jahren (M = 13.48; SD = 1.72) nahmen an der Frühinterventionsstudie zwischen April 2016 und Dezember 2017 in Heidelberg teil. Die Symptomschwere wurde zu Beginn, zum Abschluss der Gruppentherapie sowie nach 4 Monaten anhand von standardisierten Diagnostikinstrumenten erfasst. Ergebnisse: Mehrebenenanalysen zeigten eine signifikante Reduktion der Symptomschwere anhand der Computerspielabhängigkeitsskala (CSAS) nach 4 Monaten. Im Selbstbeurteilungsbogen zeigte sich ein kleiner Effekt (d = 0.35), im Elternurteil ein mittlerer Effekt (d = 0.77). Der Reliable Change Index, der anhand der Compulsive Internet Use Scale (CIUS) berechnet wurde, deutete auf eine starke Heterogenität im individuellen Symptomverlauf hin. Die Patientinnen und Patienten bewerteten das Programm zu beiden Follow-Up-Messzeitpunkten mit einer hohen Zufriedenheit. Schlussfolgerungen: Die vorliegende Arbeit stellt international eine der wenigen Studien dar, die eine Reduktion der Symptome von Computerspiel- und Internetabhängigkeit im Jugendalter über 4 Monate belegen konnte.

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Issues of geriatric otolaryngologic emergency have not been widely applied despite increase in geriatric population. (Preprint)

10.2196/preprints.13383 ◽

2019 ◽

Author(s):

Waheed Atilade Adegbiji ◽

Shuaib Kayode Aremu ◽

AbdulAkeem Adebayo Aluko

Keyword(s):

Foreign Body ◽

Head And Neck ◽

Clinical Features ◽

University Teaching ◽

Age Group ◽

Geriatric Population ◽

Female Ratio ◽

Common Diagnosis ◽

Foreign Body Impaction ◽

Nose And Throat

BACKGROUND Issues of geriatric otolaryngologic emergency have not been widely applied despite increase in geriatric population. OBJECTIVE This study aimed at determining prevalence, sociodemographic features, aetiology, clinical features, Complications and sources ofreferral of geriatric otorhinolaryngological, head and neck emergency in our center. METHODS This was a prospective hospital based study of geriatric otorhinolaryngology emergency in the Ear, Nose and Throat Department of Ekiti State University Teaching Hospital. The study was carried out between October 2016 and September 2018. Data were obtained by using pretested interviewers questionnaire.All data were collated and analyzed using SPSS version 18.0. The data were expressed by frequency table, percentage, bar charts and pie charts. RESULTS Geriatric otorhinolaryngology, head and neck emergency accounted for 5.3%. Major prevalence age group was 43.9% in the age group (60-64). There were 38.6% males with male to female ratio of 1:1.5. The main aetiology of geriatric otorhinolaryngology emergency was 29.5% trauma/road traffic accident/foreign body impaction and 25.8% tumour. Main anatomical distribution of geriatric otorhinolaryngology emergency were 38.6% throat diseases and 31.1% ear diseases. The most frequent clinical features were pain in 27.3%, hearing loss in 21.2%, tinnitus in 15.9%, bleeding in 14.4%, difficulty breathing in 12.9% and discharge in 11.4%. Common diagnosis in this study were 15.9% sinonasal tumour, 14.4% upper aerodigestive foreign body impaction, 10.6% earwax impaction and 19.8% otitis externa. Acute presentation (<13 weeks) occurred in 1 week in 74.2% and 2-13 weeks In 19.7%. Commonest time of presentation was daytime in 65.9%. Major sources of referral were 43.2% general practitioner and 31.1% casualty officers. Presentation of geriatric otorhinolaryngology emergency were mainly ear, nose and throat clinic in 59.8% with accident and emergency in 28.8%. Commonest associated comorbid illnesses among the geriatric patients were 18.2% hypertension, 14.4% arthritis and 9.8% diabetes mellitus. CONCLUSIONS Geriatric otorhinolaryngological emergency are common pathology with associated with comorbid illnesses. Detailed clinical assessment are mandatory for effective management outcome.

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Increased Return Clinic Visits for Adults with Group A Streptococcal Pharyngitis Treated with a Macrolide

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.875 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s295-s296

Author(s):

Suzette Rovelsky ◽

Benjamin Pontefract ◽

McKenna Nevers ◽

Adam Hersh ◽

Matthew Samore ◽

...

Keyword(s):

Index Date ◽

Penicillin Allergy ◽

Audit And Feedback ◽

Urgent Care ◽

Diagnostic Code ◽

Feedback Intervention ◽

Acute Pharyngitis ◽

Return Visit ◽

Group A ◽

Return Visits

Background: A multicenter audit-and-feedback intervention was conducted to improve management of acute respiratory infections (ARIs) including group A streptococcal (GAS) pharyngitis within 6 VA medical Centers (VAMCs). A relative reduction (24.8%) in azithromycin prescribing after the intervention was observed. Within these facilities during 2015–2018, 2,266 cases of GAS occurred, and susceptibility to erythromycin ranged from 55% to 70%. We evaluated whether prescribing a macrolide for GAS pharyngitis was associated with an increase in outpatient return visits. Methods: A cohort of ambulatory adults treated for GAS pharyngitis (years 2014–2019) at 6 VAMCs was created. Demographic, diagnostic, treatment, and revisit data were extracted from the Corporate Data Warehouse. GAS pharyngitis was defined by an acute pharyngitis diagnostic code combined with a GAS-positive rapid strep test or throat culture ≤3 days of index date. Antibiotic prescriptions were included if filled ≤3 days of index date and were classified as first line (penicillin/amoxicillin), second line (cephalexin/clindamycin), macrolides (azithromycin, clarithromycin, erythromycin), or other (remaining antibiotics). A return visit was defined as a new visit to primary care, urgent care, or the emergency department with a diagnostic code for an ARI ≤30 days from the index visit. Logistic regression was used to adjust for nonantibiotic covariates and to compare treatments. Results are reported as odds ratio (OR ± 95% CI; P value). Results: Of 12,666 patients with a diagnostic code for acute pharyngitis, 2,923 (23.1%) had GAS testing performed. Of those, 582 (19.9%) were GAS-positive and 460 (15.7%) received antibiotics. The mean age was 39.0 years (±SD, 11.7) and 73.7% were male. Antibiotics included penicillins for 363 patients (78.9%), cephalosporins for 21 (4.6%), clindamycin for 32 (7.0%), macrolides for 47 (10.2%), and other for 17 (3.9%). Penicillin allergy was documented in 48 patients (10.5%), and these patients received cephalosporins (18.8%), clindamycin (35.4%), macrolides (41.7%), and other antibiotics (4.2%). Return visits occurred in 47 cases (10.4%). Limited chart review indicated that 6 of 10 macrolide recipients (60.0%) with return visits had recurrence or unresolved symptoms. After adjustment for calendar month and facility, odds of a return visit for treatment with a macrolide relative to penicillins was 2.79 (OR, 1.19; 95% CI, ±6.56; P = .02). The audit-feedback intervention was not associated with ARI-related return visits (OR, 0.53; 95% CI, 0.26–1.06; P = .07). Conclusions: Return visit rates were higher for GAS pharyngitis patients treated with a macrolide than for those treated with penicillins. Macrolides were the most commonly prescribed non-penicillin therapy irrespective of penicillin allergy. Further work is necessary to determine the reason for the increase in return visits.Funding: NoneDisclosures: None

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An interview study to determine the experiences of cellulitis diagnosis amongst health care professionals in the UK

BMJ Open ◽

10.1136/bmjopen-2019-034692 ◽

2020 ◽

Vol 10 (10) ◽

pp. e034692

Author(s):

Mitesh Patel ◽

Siang Ing Lee ◽

Nick J Levell ◽

Peter Smart ◽

Joe Kai ◽

...

Keyword(s):

Clinical Features ◽

Clinical Experience ◽

Lower Limb ◽

Health Care Professionals ◽

Secondary Outcome ◽

Snowball Sampling ◽

Acute Medicine ◽

Common Diagnosis ◽

The Uk ◽

National Networks

ObjectivesTo explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis.SettingUK nationwide.Participants20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors.Primary and secondary outcomesPrimary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis.ResultsThe presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required.ConclusionCellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.

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Clinical features differentiating patients with postmortem confirmed progressive supranuclear palsy and corticobasal degeneration

Journal of Neurology ◽

10.1007/bf03161075 ◽

1999 ◽

Vol 246 (S2) ◽

pp. II1-II5 ◽

Cited By ~ 50

Author(s):

I. Litvan ◽

D. A. Grimes ◽

A. E. Lang ◽

J. Jankovic ◽

A. McKee ◽

...

Keyword(s):

Progressive Supranuclear Palsy ◽

Clinical Features ◽

Corticobasal Degeneration

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Application of MRI for the Diagnosis of Neoplasms

BioMed Research International ◽

10.1155/2018/2715831 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ewa Bejer-Oleńska ◽

Michael Thoene ◽

Andrzej Włodarczyk ◽

Joanna Wojtkiewicz

Keyword(s):

Benign Neoplasms ◽

Young Males ◽

Classification Of Diseases ◽

Icd 10 ◽

Mri Scans ◽

International Statistical Classification ◽

The Central Nervous System ◽

Spss Software ◽

The Brain

Aim. The aim of the study was to determine the most commonly diagnosed neoplasms in the MRI scanned patient population and indicate correlations based on the descriptive variables. Methods. The SPSS software was used to determine the incidence of neoplasms within the specific diagnoses based on the descriptive variables of the studied population. Over a five year period, 791 patients and 839 MRI scans were identified in neoplasm category (C00-D48 according to the International Statistical Classification of Diseases and Related Health Problems ICD-10). Results. More women (56%) than men (44%) represented C00-D48. Three categories of neoplasms were recorded. Furthermore, benign neoplasms were the most numerous, diagnosed mainly in patients in the fifth decade of life, and included benign neoplasms of the brain and other parts of the central nervous system. Conclusions. Males ≤ 30 years of age with neoplasms had three times higher MRI scans rate than females of the same age group; even though females had much higher scans rate in every other category. The young males are more often selected for these scans if a neoplasm is suspected. Finally, the number of MRI-diagnosed neoplasms showed a linear annual increase.

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