Image directed lymph node sampling for lung cancer staging

http://deepblue.lib.umich.edu/bitstream/2027.42/117374/1/40644_2014_Article_102.pd

Granulocytic sarcoma (chloroma) causing spinal cord compression

Granulocytic sarcoma (chloroma) is a rare solid tumor of myelogenous stem cells, usually appearing in patients with acute myelogenous leukemia and less commonly in patients with chronic myelogenous leukemia or myeloproliferative disorders. We present a spinal epidural granulocytic sarcoma causing thoracic spinal cord compression in a patient with chronic anemia secondary to myelofibrosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46661/1/234_2004_Article_BF00588708.pd

Amyloidosis of the spine in a patient on long-term hemodialysis

A 54-year-old man with a history of renal failure treated with hemodialysis for over 10 years presented with clinical signs and symptoms and plain radiographic, computed tomographic and magnetic resonance imaging features of cervical vertebral osteomyelitis with spinal cord compression. Decompressive surgery revealed amyloid deposition. In the setting of chronic hemodialysis, differentation between amyloid deposition and osteomyelitis may not be possible on an imaging basis necessitating biopsy for diagnosis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46659/1/234_2004_Article_BF00593058.pd

Case report 712

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46803/1/256_2004_Article_BF00243101.pd

Alexia without agraphia

Two new cases of alexia without agraphia are presented. Pertinent clinical findings, anatomy, pathophysiology and differential diagnoses are reviewed. The importance of carefully examining the inferior portion of the left side of the splenium of the corpus callosum on CT and/or MR scans in patients who present with this clinical syndrome is stressed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46660/1/234_2004_Article_BF00596338.pd

Validation of asthma recording in electronic health records: protocol for a systematic review.

BACKGROUND: Asthma is a common, heterogeneous disease with significant morbidity and mortality worldwide. It can be difficult to define in epidemiological studies using electronic health records as the diagnosis is based on non-specific respiratory symptoms and spirometry, neither of which are routinely registered. Electronic health records can nonetheless be valuable to study the epidemiology, management, healthcare use and control of asthma. For health databases to be useful sources of information, asthma diagnoses should ideally be validated. The primary objectives are to provide an overview of the methods used to validate asthma diagnoses in electronic health records and summarise the results of the validation studies. METHODS: EMBASE and MEDLINE will be systematically searched for appropriate search terms. The searches will cover all studies in these databases up to October 2016 with no start date and will yield studies that have validated algorithms or codes for the diagnosis of asthma in electronic health records. At least one test validation measure (sensitivity, specificity, positive predictive value, negative predictive value or other) is necessary for inclusion. In addition, we require the validated algorithms to be compared with an external golden standard, such as a manual review, a questionnaire or an independent second database. We will summarise key data including author, year of publication, country, time period, date, data source, population, case characteristics, clinical events, algorithms, gold standard and validation statistics in a uniform table. ETHICS AND DISSEMINATION: This study is a synthesis of previously published studies and, therefore, no ethical approval is required. The results will be submitted to a peer-reviewed journal for publication. Results from this systematic review can be used to study outcome research on asthma and can be used to identify case definitions for asthma. PROSPERO REGISTRATION NUMBER: CRD42016041798

Validation of asthma recording in the Clinical Practice Research Datalink (CPRD)

OBJECTIVES: The optimal method of identifying people with asthma from electronic health records in primary care is not known. The aim of this study is to determine the positive predictive value (PPV) of different algorithms using clinical codes and prescription data to identify people with asthma in the United Kingdom Clinical Practice Research Datalink (CPRD). METHODS: 684 participants registered with a general practitioner (GP) practice contributing to CPRD between 1 December 2013 and 30 November 2015 were selected according to one of eight predefined potential asthma identification algorithms. A questionnaire was sent to the GPs to confirm asthma status and provide additional information to support an asthma diagnosis. Two study physicians independently reviewed and adjudicated the questionnaires and additional information to form a gold standard for asthma diagnosis. The PPV was calculated for each algorithm. RESULTS: 684 questionnaires were sent, of which 494 (72%) were returned and 475 (69%) were complete and analysed. All five algorithms including a specific Read code indicating asthma or non-specific Read code accompanied by additional conditions performed well. The PPV for asthma diagnosis using only a specific asthma code was 86.4% (95% CI 77.4% to 95.4%). Extra information on asthma medication prescription (PPV 83.3%), evidence of reversibility testing (PPV 86.0%) or a combination of all three selection criteria (PPV 86.4%) did not result in a higher PPV. The algorithm using non-specific asthma codes, information on reversibility testing and respiratory medication use scored highest (PPV 90.7%, 95% CI (82.8% to 98.7%), but had a much lower identifiable population. Algorithms based on asthma symptom codes had low PPVs (43.1% to 57.8%)%). CONCLUSIONS: People with asthma can be accurately identified from UK primary care records using specific Read codes. The inclusion of spirometry or asthma medications in the algorithm did not clearly improve accuracy. ETHICS AND DISSEMINATION: The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number15_257) and the approved protocol was made available to the journal and reviewers during peer review. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority Research Ethics Committee (East Midlands-Derby, REC reference number 05/MRE04/87).The results will be submitted for publication and will be disseminated through research conferences and peer-reviewed journals

Concomitant diagnosis of asthma and COPD:a quantitative study in UK primary care

Background: Asthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment.Aim: To quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.Design and setting: Patients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires.Method: The prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information.Results: In total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, n = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD.Conclusion: A concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.</p

Cardiovascular outcomes following a respiratory tract infection among adults with non-CF bronchiectasis: a general population based study

Rationale: Studies suggest that people with bronchiectasis are at increased risk of cardiovascular co-morbidities. Objectives: We aimed to quantify the relative risk of incident cardiovascular events following a respiratory tract infection amongst people with bronchiectasis. Methods: Using UK electronic primary care records, we conducted a within-person comparison using the self-controlled case series method. We calculated the relative risk of first time cardiovascular events (either first myocardial infarction [MI] or stroke) following a respiratory tract infection compared with the individual’s baseline risk. Results: Our cohort consisted of 895 individuals with non-CF bronchiectasis with a first MI or stroke and at least one respiratory tract infection. There was an increased rate of first time cardiovascular events in the 91 day period after a respiratory tract infection (Incidence Rate Ratio [IRR] 1.56; 95% CI 1.20 to 2.02). The rate of a first cardiovascular event was highest in the first three days following a respiratory tract infection (IRR 2.73, 95% CI 1.41 to 5.27). Conclusions: These data suggest that respiratory tract infections are strongly associated with a transient increased risk of first time MI or stroke amongst people with bronchiectasis. As respiratory tract infections are six times more common in people with bronchiectasis than the general population, the increased risk has a disproportionately greater impact in these individuals. These findings may have implications for including cardiovascular risk modifications in airway infection treatment pathways in this population

Emergency MR imaging of the central nervous system

Magnetic resonance (MR) of the central nervous system has few, but important indications for use in the acute setting. This report reviews the few true current clinical indications for emergency MR imaging, including ruling out spinal cord compression, vascular dissection or dural venous sinus thrombosis. Possible indications for emergency MR, including evaluation of acute stroke symptomatology, potential meningoencephalitis or vasculitis, are also presented. Future applications for MR, including MR angiography in the setting of acute subarachnoid hemorrhage and spectroscopy in acute ischemia, are mentioned.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42348/1/10140-6-3-133_90060133.pd