Use of vonoprazan for management of systemic sclerosis‑related gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) can significantly reduce a patient\u27s quality of life. GERD in SSc is occasionally resistant to conventional anti-acid treatment. Vonoprazan is an H+/K+-ATPase blocker that is approved in Japan for treatment of GERD. The aim of the present study was to evaluate the efficacy of vonoprazan in SSc-related GERD. The frequency scale for symptoms of GERD (FSSG) scores were collected before and after vono-prazan treatment in 15 SSc patients with GERD. Additionally, endoscopic esophagogastroduodenoscopy was performed in select patients. Conventional proton pump inhibitors or hista-mine-2 receptor antagonists had been previously administered in 93% (14/15) of the patients. Although the baseline esophago-gastroduodenoscopy examination did not show severe erosion in the majority of patients,the mean total FSSG score before vonoprazan treatment was notably high (25.2±10.7) compared to a normal score of <8. After vonoprazan treatment, the FSSG score decreased to 9.6±7.0. The mean improvement rate of the total FSSG, acid reflux and dysmotility scores were 60.8±21.2% (P=0.0004), 67.3±24.8% (P<0.0001) and 55.4±26.0% (P=0.0022), respectively.These results suggest that vonoprazan may be a potentially effective treatment for GERD in patients with SSc

Strategies for Clinical Decision Support for Electronic Case Reporting

ObjectiveTo discuss how clinical decision support (CDS) for electronic case reporting (eCR) will evolve over time to provide multiple deployment modelsIntroductionAs the knowledge required to support case reporting evolves from unstructured to more structured and standardized formats, it becomes suitable for electronic clinical decision support (CDS). CDS for case reporting confronts two challenges: a) While EHRs are moving toward local CDS capabilities, it will take several years for EHR systems to consistently support this capability; and b) public health-related CDS knowledge, such as Zika infection detection and reporting rules, may differ from jurisdiction to jurisdiction. Therefore, there is an ongoing need to manage reporting rules in a distributed manner. Similarly, there is a need for more decentralized models of CDS execution to overcome some of the disadvantages of centralized deployment and to leverage local CDS capabilities as they become available over the next several years.MethodsThe Reportable Condition Knowledge Management System (RCKMS) is a project funded by the CDC, through the Council of State and Territorial Epidemiologists (CSTE), to develop a tool that allows jurisdictions to author rules that define whether a patient is reportable for certain conditions. RCKMS includes a Decision Support Service (DSS) that runs the jurisdictions’ rules and determines if a patient is reportable, for which condition(s) and to which jurisdiction(s). RCKMS currently plays a significant role in the broader Digital Bridge project that has been working to provide structure and governance around the national planning and implementation effort of eCR. RCKMS is currently a centralized CDS service that can be accessed by EHRs until they all have local CDS capabilities; and a knowledge authoring environment that allows ongoing distributed rule authoring. RCKMS supports the strategy for public health knowledge management, and it will evolve over time to provide the systems and services to satisfy short-, mid-, and long-term public health CDS requirements. In addition, RCKMS will comply with emerging technical standards that support this work.ResultsRCKMS is currently being deployed as a single, central, national service on the APHL Informatics Messaging Services (AIMS) platform, which is operated and maintained by Association of Public Health Laboratories (APHL). The AIMS platform connects directly with reporters and provides a routing and validation service for incoming and outgoing messages. Two distributed CDS scenarios for decentralized eCR models have been identified. In the first scenario, the Decision Support Service component of the RCKMS software is installed within a clinical organization (as it would be in a centralized service) and executed locally. The second distributed CDS scenario for eCR involves the distribution of the Reporting Specification rules without the software. In this scenario, local electronic health record (EHR) implementations would be required to consume the Reporting Specifications and utilize them in a CDS capability within their EHR.ConclusionsIt is expected that given the diversity of organizations, systems, and architectures in the United States that multiple deployment scenarios for CDS for eCR will be simultaneously deployed for the foreseeable future. It cannot be stressed enough, however, that in all scenarios – centralized and distributed – there must be a centralized and uniform authoring of the Reporting Specification rules, since the specifications themselves originate from public health through a centralized process and must be administered nationally through a well-established process. It is also essential that all sites have all the rules available to them, since there may be multiple jurisdictions whose rules and reporting is required, with the determination of jurisdiction(s) based on where a patient lives and where they receive care. 

Recommendations for Syndromic Surveillance Using Inpatient and Ambulatory EHR Data

This presentation will review the process and the details of the recommendations developed by the multi-stakeholder ISDS Meaningful Use Workgroup to develop guidelines for conducting syndromic surveillance using electronic health record (EHR) data from hospital inpatient and ambulatory clinical care settings. The Recommendations outline priority uses for these data and the data elements specified to support those uses. This work will facilitate the adoption of the Stage 2 and Stage 3 Meaningful Use rules for exchanging health information between clinical settings and public health authorities for the purpose of improving patient and population health

Recommendations for Syndromic Surveillance Using Inpatient and Ambulatory EHR Data

OBJECTIVE: To develop national Stage 2 Meaningful Use (MUse) recommendations for syndromic surveillance using hospital inpatient and ambulatory clinical care electronic health record (EHR) data. INTRODUCTION: MUse will make EHR data increasingly available for public health surveillance. For Stage 2, the Centers for Medicare & Medicaid Services (CMS) regulations will require hospitals and offer an option for eligible professionals to provide electronic syndromic surveillance data to public health. Together, these data can strengthen public health surveillance capabilities and population health outcomes (Figure 1). To facilitate the adoption and effective use of these data to advance population health, public health priorities and system capabilities must shape standards for data exchange. Input from all stakeholders is critical to ensure the feasibility, practicality, and, hence, adoption of any recommendations and data use guidelines. METHODS: ISDS, in collaboration with the Division of Informatics Solutions and Operations at the Centers for Disease Control and Prevention (CDC), and HLN Consulting, convened a multi-stakeholder Work-group of clinicians, technologists, epidemiologists, and public health officials with expertise in syndromic surveillance. Recommended MUse guidelines were developed by performing an environmental scan of current practice and by using an iterative, expert and community input-driven process. The Workgroup developed initial guidelines and then solicited and received feedback from the stakeholder community via interview, e-mail, and structured surveys. Stakeholder feedback was analyzed using quantitative and qualitative methods and used to revise the recommendations. RESULTS: 1. Monitoring population health; Informing public health services; and. Informing interventions, health education, and policy by characterizing the burden of chronic disease and health disparities. Similarly, the Workgroup identified data elements to support these uses in the hospital inpatient setting and possibly in the ambulatory care setting. They were aligned to previously identified emergency department and urgent care center data elements and Stage 1–2 clinical MUse objectives. Core data elements (required for certification) cover treating facility; patient demographics; subjective and objective clinical findings, including chief complaint, body mass index, smoking history, diagnoses; and outcomes. Other data elements were designated as extended (not required for certification) or future (for future consideration). The data elements and their specifications are subject to change based on applicable state and local laws and practices. Based on their findings and recommended guidelines detailed in the report, the Workgroup also identified community activities and additional investments that would best support public health agencies in using EHR technology with syndromic surveillance methodologies. CONCLUSIONS: The widespread adoption of EHRs, catalyzed by MUse, has the potential to improve population health. By identifying and describing potential ESS uses of new sources of EHR data and associated data elements with the greatest utility for public health, the recommendations set forth by the ISDS MUse Workgroup will serve to facilitate the adoption of MUse policy by both healthcare and public health agencies

Determination of Serum 25-Hydroxyvitamin D-3 by LC/MS/MS and Its Monthly Variation in Sapporo Indoor Workers

25-Hydroxyvitamin D-3 (25(OH)D-3) as the metabolite of vitamin D, is connected with various of diseases, and important to people with limited sunshine. Thus, the investigation of serum 25-hydroxyvitamin D and its variation in these people is necessary. In this study, a simple, precise, and accurate method for serum 25(OH)D-3 determination by LC/MS/MS was developed. Serum samples were obtained monthly for one year from 11 male and 11 female indoor workers in Sapporo, Japan, and the overall 25(OH)D-3 concentration was 12.9 +/- 4.7 ng/mL. The 25(OH)D-3 in females was significantly lower than that in males (14.0 +/- 5.0 vs. 11.9 +/- 4.3 ng/mL). The serum 25(OH)D-3 concentration in males and females were both strongly correlated to UV-B radiation (r(2) = 0.8477 and 0.7384, respectively), with a two-month's lag. Also the monthly change in 25(OH)D-3 in males was more significant than that in females