Identification of subjects with polycystic ovary syndrome using electronic health records

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder because of the variable criteria used for diagnosis. Therefore, International Classification of Diseases 9 (ICD-9) codes may not accurately capture the diagnostic criteria necessary for large scale PCOS identification. We hypothesized that use of electronic medical records text and data would more specifically capture PCOS subjects. Methods: Subjects with PCOS were identified in the Partners Healthcare Research Patients Data Registry by searching for the term “polycystic ovary syndrome” using natural language processing (n = 24,930). A training subset of 199 identified charts was reviewed and categorized based on likelihood of a true Rotterdam PCOS diagnosis, i.e. two out of three of the following: irregular menstrual cycles, hyperandrogenism and/or polycystic ovary morphology. Data from the history, physical exam, laboratory and radiology results were codified and extracted from notes of definite PCOS subjects. Thirty-two terms were used to build an algorithm for identifying definite PCOS cases and applied to the rest of the dataset. The positive predictive value cutoff was set at 76.8 % to maximize the number of subjects available for study. A true positive predictive value for the algorithm was calculated after review of 100 charts from subjects identified as definite PCOS cases with at least two documented Rotterdam criteria. The positive predictive value was compared to that calculated using 200 charts identified using the ICD-9 code for PCOS (256.4; n = 13,670). In addition, a cohort of previously recruited PCOS subjects was submitted for algorithm validation. Results: Chart review demonstrated that 64 % were confirmed as definitely PCOS using the algorithm, with a 9 % false positive rate. 66 % of subjects identified by ICD-9 code for PCOS could be confirmed as definitely PCOS, with an 8.5 % false positive rate. There was no significant difference in the positive predictive values using the two methods (p = 0.2). However, the number of charts that had insufficient confirmatory data was lower using the algorithm (5 % vs 11 %; p < 0.04). Of 477 subjects with PCOS recruited and examined individually and present in the database as patients, 451 were found within the algorithm dataset. Conclusions: Extraction of text parameters along with codified data improves the confidence in PCOS patient cohorts identified using the electronic medical record. However, the positive predictive value was not significantly different when using ICD-9 codes or the specific algorithm. Further studies are needed to determine the positive predictive value of the two methods in additional electronic medical record datasets. Electronic supplementary material The online version of this article (doi:10.1186/s12958-015-0115-z) contains supplementary material, which is available to authorized users

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

Motor vehicle collisions (MVCs) are the second most common form of trauma among older adults. We sought to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after an MVC

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Swear words used in Fast and Furious movie series

This research focuses on swear words found in Fast and Furious Movie Series. The aims of this research are to describe the kinds of swear words, the users of swear words and the purposes of uttering swear words. Pragmatic equivalent method is used to describe the kinds of swear words,the users of swear words and the purposes of uttering swear words. In getting the data, the researcher used field research. The data were taken from movie series entitled Fast and Furious; The Fast and The Furious (2001), 2 Fast 2 Furious (2003), The Fast and The Furious Tokyo Drift, Fast and Furious (2009), Fast Five (2011) and Furious 6 (2013). The result of the analysis showed that there were 135 data of swear words based on Hughes's classifications; they were swear words related to sex (20items), swear words related to excrement (51 items), swear words related to name of animal (13 items), swear words related to personal background (6 items), swear words related to sexual activity (4 items), swear words related to taboo or religion or oath (38 items) and swear words related to mental illness (3 items). Moreover, the users of swear words are elaborated in the basis of Holmes's classifications. There were two aspects which influence the users of swear words.The first was the users of swear words based on age. It was divided into swear words which were uttered by youngsters (117 items) and swear words which were uttered by old generation (18 items). The second was the users of swear words based on gender and occupation. It was divided into swear words which were uttered by men (121 items) and swear words which were uttered by women (14items). Furthermore, the purposes of uttering swear words are categorized based on Eric Partridge's classifications. They were swear words used to express anger (87items), swear words used to degrade or put down (10 items), swear words used to express a response of shock (3 items), swear words used to express protest (9items), swear words used to express intimacy (5 items) and the last classification was swear words used to identify a certain profession (21 items)

Dietary Sodium Restriction: Take It with a Grain of Salt

The American Heart Association recently strongly recommended a dietary sodium intake o

Additional file 1: Figure S1. of Identification of subjects with polycystic ovary syndrome using electronic health records

Datamart calibration. The circles represent A) the initial broad datamart identified using codified data, B) the second refined datamart in which electronic notes with the words polycystic ovary syndrome or PCOS were found, and C) patients from the entire Research Population Data Registry database, without codified exclusion criteria. The overlap represents patients that were found using both codified data and with a PCOS term in the note (AXB) or patients with a PCOS term in the note and without exclusion criteria (BXC). Of note, patients without exclusion criteria are also found in A and AXB, but are not shown here for clarity. The numbers in the orange circles represent the number of charts with a confirmed PCOS diagnosis over the total number of charts reviewed by an expert (CKW) and the percentage confirmed. The white box indicates the patients with evaluable charts who were not included in the broad definition datamart (no codified terms identified) but who did have a PCOS term in their note and were included in the refined datamart. Table S1. ICD 9 codes for diagnoses and procedures and laboratory values used for inclusion and exclusion in the broad PCOS datamart. Patients were all female, 18-74 years of age (current), with any of the listed parameters measured at Massachusetts General Hospital or Brigham and Women’s Hospital. Table S2. Inclusion and exclusion criteria used to create the second refined PCOS datamart. Patients were all female, 18-40 years of age at first identification of any listed parameter from records at Massachusetts General Hospital or Brigham and Women’s Hospital. (DOCX 36 kb

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

Motor vehicle collisions (MVCs) are the second most common form of trauma among older adults. We sought to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after an MVC