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Farrokh Alemi, Cari R Levy, Raya E Kheirbek
BACKGROUND: The Multimorbidity (MM) Index predicts the prognosis of patients from their diagnostic history. In contrast to existing approaches with broad diagnostic categories, it treats each diagnosis as a separate independent variable using individual International Classification of Disease, Revision 9 (ICD-9) codes. OBJECTIVE: This paper describes the MM Index, reviews the published data on its accuracy, and provides procedures for implementing the Index within electronic health record (EHR) systems...
2016: EGEMS
Amit G Singal, Jasmin A Tiro, Jorge A Marrero, Katharine McCallister, Caroline Mejias, Brian Adamson, Wendy Pechero Bishop, Noel O Santini, Ethan A Halm
BACKGROUND & AIMS: Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma (HCC) and prolongs survival. However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status. We compared effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for HCC in a racially diverse and socioeconomically disadvantaged cohort...
November 5, 2016: Gastroenterology
Frederick Kofi Korley, Ramon Diaz-Arrastia, Hayley J Falk, Matthew E Peters, Jeannie-Marie S Leoutsakos, Durga Roy, Vani Rao, Haris I Sair, Uju Ofoche, Anna J Hall, Freshta Akbari, Timothy E Van Meter, Allen D Everett, Jennifer Van Eyk, Kathleen T Bechtold
Head injury patients not meeting the American Congress of Rehabilitation Medicine (ACRM)'s criteria for mild traumatic brain injury (mTBI), referred to hereafter as HIBRID (Head Injury BRain Injury Debatable) are often excluded from studies. The prognostic importance of HIBRID is unclear. We investigated the differences in functional and symptomatic recovery at one month after injury among TBI patients classified as: HIBRID, ACRM+ cranial CT-, and cranial CT+; and trauma and healthy controls. Subjects were enrolled in an ongoing prospective cohort (Head Injury Serum Markers for Assessing Response to Trauma, HeadSMART)...
October 26, 2016: Journal of Neurotrauma
Oruganti Sai Satish, K Sashikanth Srivastav
Till recently, ST segment elevation in the absence of conduction abnormalities or chest pain occurring particularly in young bradycardia individuals has been considered a normal variant called early repolarisation (ER). However, recent studies suggest a more worrisome picture as patients with history of idiopathic ventricular fibrillation showed increased prevalence of ER in ECG. ER is an ECG pattern characterised by elevation of the QRS-ST junction (J point) ≥ 2 mv from baseline in the inferior (II, III, aVF) or lateral (I, aVL, V4-V6) leads manifested as QRS slurring or notching...
July 2016: Journal of the Association of Physicians of India
Dea Seidenfaden, Ulla Knorr, Mia Greisen Soendergaard, Henrik Enghusen Poulsen, Anders Fink-Jensen, Martin Balslev Jorgensen, Anders Jorgensen
BACKGROUND: Childhood adversity is a well-established risk factor for the development of schizophrenia. In particular, there is evidence that childhood adversity increases the occurrence of positive symptoms, possibly through glucocorticoid influences on dopaminergic neurotransmission. AIMS: To compare levels of childhood trauma in schizophrenia patients vs. healthy control persons, and to study the association between childhood adversity and the symptomatology of adulthood schizophrenia, as well as subjective and biological markers of psychological stress...
January 2017: Comprehensive Psychiatry
Svetlana A Ivanova, Diana Z Osmanova, Maxim B Freidin, Olga Yu Fedorenko, Anastasia S Boiko, Ivan V Pozhidaev, Arkadiy V Semke, Nikolay A Bokhan, Alexey A Agarkov, Bob Wilffert, Anton J M Loonen
OBJECTIVES: Hyperprolactinaemia (HPRL) is a classical side effect of antipsychotic drugs primarily attributed to blockade of dopamine D2 subtype receptors in the pituitary gland. Although dopamine is considered the primary factor inhibiting prolactin release, the activity of prolactin-producing lactotrophs is also regulated by the secretagogues thyrotrophin releasing hormone, vasoactive intestinal polypeptide and serotonin (5-hydroxytryptamine; 5-HT). METHODS: We describe the association between HPRL and a set of 29 SNPs from 5-HT receptor genes HTR1A, HTR1B, HTR2A, HTR2C, HTR3A, HTR3B and HTR6 in a population of 446 Caucasians (221 males/225 females) with a clinical diagnosis of schizophrenia (according to ICD-10: F20) who were treated with classical and/or atypical antipsychotic drugs...
September 22, 2016: World Journal of Biological Psychiatry
Ian C Y Chang, Yusuf M Agamawi, Erin Austin, Wayne O Adkisson, Henri Roukoz, Lisa N von Wald, Scott Sakaguchi, David G Benditt, Lin Y Chen
Whether the risk factors for cardiovascular (CV) outcomes are different in primary versus secondary prevention implantable cardioverter-defibrillator (ICD) patients is unclear. We sought to identify predictors of CV outcomes in ICD recipients for primary (G1) versus secondary prevention (G2). Consecutive patients who had ICD implanted during August 2005 to December 2009 were included. The primary outcome was a composite of appropriate shock, acute coronary syndrome, ischemic stroke, coronary revascularization, heart failure exacerbation, CV hospitalization, or all-cause death...
August 23, 2016: American Journal of Cardiology
Stephen A Metcalf, Peter B Jones, Tanja Nordstrom, Markku Timonen, Pirjo Mäki, Jouko Miettunen, Erika Jääskeläinen, Marjo-Riitta Järvelin, Jan Stochl, Graham K Murray, Juha Veijola, Golam M Khandaker
OBJECTIVE: Meta-analyses of cross-sectional studies confirm an increase in circulating inflammatory markers during acute psychosis. Longitudinal studies are scarce but are needed to understand whether elevated inflammatory markers are a cause or consequence of illness. We report a longitudinal study of serum C-reactive protein (CRP) in adolescence and subsequent risk of schizophrenia and related psychoses in adulthood in the Northern Finland Birth Cohort 1986. METHOD: Serum high-sensitivity CRP was measured at age 15/16 years in 6362 participants...
September 10, 2016: Brain, Behavior, and Immunity
Anthony Li, Amit Kaura, Nicholas Sunderland, Paramdeep S Dhillon, Paul A Scott
Large-scale implantable cardioverter defibrillator (ICD) trials have unequivocally shown a reduction in mortality in appropriately selected patients with heart failure and depressed left ventricular function. However, there is a strong association between shocks and increased mortality in ICD recipients. It is unclear if shocks are merely a marker of a more severe cardiovascular disease or directly contribute to the increase in mortality. The aim of this review is to examine the relationship between ICD shocks and mortality, and explore possible mechanisms...
August 2016: Arrhythmia & Electrophysiology Review
Jinkwon Kim, Tae-Jin Song, Dongbeom Song, Joonsang Yoo, Jang-Hyun Baek, Hye Sun Lee, Chung Mo Nam, Hyo Suk Nam, Young Dae Kim, Ji Hoe Heo
BACKGROUND AND AIMS: Proteinuria is a marker of kidney disease and a strong risk factor for cardiovascular diseases including stroke. This study was aimed at investigating the prognostic value of proteinuria measured by urine dipstick in patients with acute ischemic stroke. METHODS: This post-hoc analysis of a prospective cohort study included 3404 consecutive patients who had been admitted for acute ischemic stroke between November 2005 and June 2013. Proteinuria was defined as a trace or more of protein on a urine dipstick test routinely performed at admission...
October 2016: Atherosclerosis
Parikshit S Sharma, Pierre Bordachar, Kenneth A Ellenbogen
The implantable cardiac defibrillator (ICD) has been an effective tool for prevention of sudden cardiac death (SCD) in populations at high risk for life-threatening sustained ventricular tachycardia (VT) and ventricular fibrillation (VF). However, ICD implantation is dependent on defining ventricular substrate, evaluating the future risk of SCD and estimation of the patient's overall survival. The ability to predict risk of SCD is often difficult. If ventricular dysfunction (a surrogate marker for the risk of SCD) improves, ICD therapy may not be indicated...
August 25, 2016: European Heart Journal
Joshua Rolnick, N Lance Downing, John Shepard, Weihan Chu, Julia Tam, Alexander Wessels, Ron Li, Brian Dietrich, Michael Rudy, Leon Castaneda, Lisa Shieh
BACHGROUND: Increasing use of EHRs has generated interest in the potential of computerized clinical decision support to improve treatment of sepsis. Electronic sepsis alerts have had mixed results due to poor test characteristics, the inability to detect sepsis in a timely fashion and the use of outside software limiting widespread adoption. We describe the development, evaluation and validation of an accurate and timely severe sepsis alert with the potential to impact sepsis management...
2016: Applied Clinical Informatics
Julian Casciano, Jerry A Krishnan, Mary Buatti Small, Philip O Buck, Gokul Gopalan, Chenghui Li, Robert Kemp, Zenobia Dotiwala
BACKGROUND: Asthma is a common chronic condition with an economic burden of almost $56 billion annually in the US. Biologic markers like blood eosinophils, that help predict the risk of exacerbation could help guide more optimal treatment plans and reduce cost. The purpose of this study was to determine whether healthcare resource use and expenditures vary by eosinophil level among patients with asthma. METHODS: Patients with a diagnosis of asthma defined by ICD-9-CM code 493...
2016: BMC Pulmonary Medicine
Margarita Kushnir, Hillel W Cohen, Henny H Billett
In patients with cancer and myeloproliferative disorders, leukocytosis has been associated with an increased venous thromboembolic (VTE) risk. Our goal was to determine whether persistent neutrophilia (PN), not associated with known causes such as malignancies, infections or steroids, is independently associated with VTE. All adult patients with >3 outpatient complete blood counts (CBCs) within 3 years were included. PN was defined as having an absolute neutrophil count >95 % (>2SD) of the population (≥7...
November 2016: Journal of Thrombosis and Thrombolysis
Nicolas Carriere, Jean-Louis Bourriez, Arnaud Delval, Philippe Derambure, Luc Defebvre, Kathy Dujardin
BACKGROUND: Impulse control disorders (ICDs) in Parkinson's disease (PD) are related to treatment with dopamine agonists, which is thought to deregulate the dopaminergic mesolimbic pathway and impair reward evaluation. EEG studies in healthy controls (HCs) have suggested that the increase in theta power observed after negative outcome is a marker of reward processing. OBJECTIVE: To compare outcome-locked, event-related spectral perturbation in a gambling task in PD patients with and without ICDs and in HCs...
June 28, 2016: Journal of Parkinson's Disease
A Wang, R Ramjeesingh, C H Chen, D Hurlbut, N Hammad, L M Mulligan, C Nicol, H E Feilotter, S Davey
BACKGROUND: Epithelial cell adhesion molecule (epcam) is a multifunctional transmembrane glycoprotein expressed on both normal epithelium and epithelial neoplasms such as gastric, breast, and renal carcinomas. Recent studies have proposed that the proteolytic cleavage of the intracellular domain of epcam (epcam-icd) can trigger signalling cascades leading to aggressive tumour behavior. The expression profile of epcam-icd has not been elucidated for primary colorectal carcinoma. In the present study, we examined epcam-icd immunohistochemical staining in a large cohort of patients with primary colorectal adenocarcinoma and assessed its performance as a potential prognostic marker...
June 2016: Current Oncology
Joachim Seegers, Leonard Bergau, Pascal Muñoz Expósito, Axel Bauer, Thomas H Fischer, Lars Lüthje, Gerd Hasenfuß, Tim Friede, Markus Zabel
In patients treated with implantable cardioverter defibrillator (ICD), prediction of both overall survival and occurrence of shocks is important if improved patient selection is desired. We prospectively studied the predictive value of biomarkers and indexes of cardiac and renal function and spectral microvolt T-wave alternans testing and 24-hour Holter variables in a population who underwent first ICD implantation. Consecutive patients in sinus rhythm with ischemic or dilated cardiomyopathy scheduled for primary or secondary prophylactic ICD implantation were enrolled...
July 1, 2016: American Journal of Cardiology
Yiyi Zhang, Eliseo Guallar, Robert G Weiss, Michael Stillabower, Gary Gerstenblith, Gordon F Tomaselli, Katherine C Wu
BACKGROUND: Left ventricular ejection fraction (LVEF) improves over time in 25%-40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. OBJECTIVES: We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. METHODS: We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar...
August 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Ankur Kalra, Kevin M Harris, Bradley A Maron, Martin S Maron, Ross F Garberich, Tammy S Haas, John R Lesser, Barry J Maron
Refractory progressive heart failure (HF) is becoming the predominant cause of mortality in nonobstructive hypertrophic cardiomyopathy (HC). To anticipate development of this important and often unpredictable clinical course, we investigated whether left ventricular diastolic dysfunction, assessed by echocardiographic Doppler parameters, could identify a subset of patients with HC without obstruction at rest who would experience progression of HF. Diastolic function parameters, assessed by Doppler tissue imaging (DTI), mitral inflow, and pulmonary venous flow were measured in 274 consecutive adult patients with HC evaluated from 2003 to 2007...
June 1, 2016: American Journal of Cardiology
Tor Biering-Sørensen, Flemming Javier Olsen, Katrine Storm, Thomas Fritz-Hansen, Niels Thue Olsen, Christian Jøns, Michael Vinther, Peter Søgaard, Niels Risum
AIMS: Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention receive appropriately therapy. We sought to investigate the value of tissue Doppler imaging (TDI) to predict ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiovascular mortality (CVD) in patients with primary prevention ICD. METHODS AND RESULTS: In total, 151 ICD patients meeting primary prevention criteria and with no history of ventricular arrhythmias were included...
July 2016: European Heart Journal Cardiovascular Imaging
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