HEMIC Project: Design of a Clinical Information Modelling Tool Based on ISO13972 Technical Specification

The Andalusian Health Service is the public healthcare provider for 8.302.923 inhabitants in the South Spain. This organization coordinates primary and specialized care with an IT infrastructure composed by multiple Electronic Health Record Systems. According to the large volume of healthcare professionals involved, there is a need for providing a consistent management of information through multiple locations and systems. The HEMIC project aims to address this need developing and validating a methodology based on a software tool for standardizing information contained within EHR systems. The developed tool has been designed for supporting the participation of healthcare professionals the establishment of mechanisms for information governance. This research presents the requirements and designs for of a software tool focused on the adoption of recognized best practice in clinical information modeling. The designed tool has a Service Oriented Architecture that will be able to integrate terminology servers and repositories of clinical information models as part of the modeling process. Moreover, the defined tool organizes clinicians, IT developers and terminology experts involved in the modeling process in three levels to promote their coordination in the definition, specialization and validation of clinical information models. In order to ensure the quality of the developed clinical information models, the defined tool is based on the requirements defined in the ISO13972 Technical Specification

Impact of co-morbidities on loss and lack of response to anti-TNFs in inflammatory bowel disease: VERNE study

Background Although anti-TNFα therapy is an effective approach for IBD, a great amount of patients does not respond to induction therapy and a significant proportion loses response over time, making it necessary to search for accurate prognostic markers to guide patient selection. This study aimed to evaluate the impact of the co-morbidities profile on the response to anti-TNFs in IBD patients treated in Spanish hospitals. Methods This was a retrospective, non-interventional, multi-centre (24 sites), observational study that included consecutive adult patients diagnosed with UC or CD who started treatment with biologics between June 2011 and June 2013. Data about patient characteristics, including comorbidities, were collected. Studied variables were analysed descriptively. Results Three hundred and ten patients with IBD were analysed, 194 with CD and 116 with ulcerative colitis. Average age was 44.9 years (SD: 13), 53.5% were male and most of them Caucasian (95.8%). CD locations were ileum and colon (44.6%), terminal ileum (37.3%), colon (15.5%) and upper gastrointestinal tract (2.6%); UC locations were extensive colitis (48.2%), left colitis (43.8%) and proctitis (8.0%). Most frequent comorbidities were: Chronic Obstructive Pulmonary Disease (COPD) (3.7%), connective tissue disease (3.0%), diabetes mellitus (2.3%), mild chronic hepatopathy (2.0%), myocardial infarction (1.7%), solid tumours (1.7%), congestive heart failure (1.3%) and cerebrovascular disease (1.3%). Logistic regression models showed that COPD was an independent factor associated with lack of response (OR 2.67 CI 95%: 1.33–5.35; p = 0.006), and myocardial infarction of loss of response (OR 3.30; CI 95%: 1.48–7.35; p = 0.003) to anti-TNF therapy. The concomitant use of corticosteroids was an additional independent factor associated with lack of response (OR 2.16; CI 95%: 1.25–3.73; p = 0.006) and loss of response (OR 2.45; CI 95%: 1.35–4.44; p = 0.003), and, in contrast, CD was a negative independent predictor of lack of response (OR 0.59; CI 95%: 0.37–0.93; p = 0.024) and loss of response (OR 0.58; CI 95%: 0.34–0.99; p = 0.044). Conclusions In this population of IBD patients who received first anti-TNF treatment, the most frequent comorbidities were COPD, connective tissue disease, diabetes and hepatopathies. Those associated with lack and loss of response were COPD and myocardial infarction, respectively. Results suggest that patients characteristics should be considered when selecting the optimal biological treatment for IBD patients

The burden of mild asthma: Clinical burden and healthcare resource utilisation in the NOVELTY study

Background: Patients with mild asthma represent a substantial proportion of the population with asthma, yet there are limited data on their true burden of disease. We aimed to describe the clinical and healthcare resource utilisation (HCRU) burden of physician-assessed mild asthma. Methods: Patients with mild asthma were included from the NOVEL observational longiTudinal studY (NOVELTY; NCT02760329), a global, 3-year, real-world prospective study of patients with asthma and/or chronic obstructive pulmonary disease from community practice (specialised and primary care). Diagnosis and severity were based on physician discretion. Clinical burden included physician-reported exacerbations and patient-reported measures. HCRU included inpatient and outpatient visits. Results: Overall, 2004 patients with mild asthma were included; 22.8% experienced ≥1 exacerbation in the previous 12 months, of whom 72.3% experienced ≥1 severe exacerbation. Of 625 exacerbations reported, 48.0% lasted >1 week, 27.7% were preceded by symptomatic worsening lasting >3 days, and 50.1% required oral corticosteroid treatment. Health status was moderately impacted (St George's Respiratory Questionnaire score: 23.5 [standard deviation ± 17.9]). At baseline, 29.7% of patients had asthma symptoms that were not well controlled or very poorly controlled (Asthma Control Test score <20), increasing to 55.6% for those with ≥2 exacerbations in the previous year. In terms of HCRU, at least one unscheduled ambulatory visit for exacerbations was required by 9.5% of patients, including 9.2% requiring ≥1 emergency department visit and 1.1% requiring ≥1 hospital admission. Conclusions: In this global sample representing community practice, a significant proportion of patients with physician-assessed mild asthma had considerable clinical burden and HCRU

Notes for genera – Ascomycota

Knowledge of the relationships and thus the classification of fungi, has developed rapidly with increasingly widespread use of molecular techniques, over the past 10--15 years, and continues to accelerate. Several genera have been found to be polyphyletic, and their generic concepts have subsequently been emended. New names have thus been introduced for species which are phylogenetically distinct from the type species of particular genera. The ending of the separate naming of morphs of the same species in 2011, has also caused changes in fungal generic names. In order to facilitate access to all important changes, it was desirable to compile these in a single document. The present article provides a list of generic names of Ascomycota (approximately 6500 accepted names published to the end of 2016), including those which are lichen-forming. Notes and summaries of the changes since the last edition of `Ainsworth Bisby's Dictionary of the Fungi' in 2008 are provided. The notes include the number of accepted species, classification, type species (with location of the type material), culture availability, life-styles, distribution, and selected publications that have appeared since 2008. This work is intended to provide the foundation for updating the ascomycete component of the ``Without prejudice list of generic names of Fungi'' published in 2013, which will be developed into a list of protected generic names. This will be subjected to the XIXth International Botanical Congress in Shenzhen in July 2017 agreeing to a modification in the rules relating to protected lists, and scrutiny by procedures determined by the Nomenclature Committee for Fungi (NCF). The previously invalidly published generic names Barriopsis, Collophora (as Collophorina), Cryomyces, Dematiopleospora, Heterospora (as Heterosporicola), Lithophila, Palmomyces (as Palmaria) and Saxomyces are validated, as are two previously invalid family names, Bartaliniaceae and Wiesneriomycetaceae. Four species of Lalaria, which were invalidly published are transferred to Taphrina and validated as new combinations. Catenomycopsis Tibell Constant. is reduced under Chaenothecopsis Vain., while Dichomera Cooke is reduced under Botryosphaeria Ces. De Not. (Art. 59)