Application and optimisation of the Comparison on Extreme Laboratory Tests (CERT) algorithm for detection of adverse drug reactions: Transferability across national boundaries.

PURPOSE: The Singapore regulatory agency for health products (Health Sciences Authority), in performing active surveillance of medicines and their potential harms, is open to new methods to achieve this goal. Laboratory tests are a potential source of data for this purpose. We have examined the performance of the Comparison on Extreme Laboratory Tests (CERT) algorithm, developed by Ajou University, Korea, as a potential tool for adverse drug reaction detection based on the electronic medical records of the Singapore health care system. METHODS: We implemented the original CERT algorithm, comparing extreme laboratory results pre- and post-drug exposure, and 5 variations thereof using 4.5 years of National University Hospital (NUH) electronic medical record data (31 869 588 laboratory tests, 6 699 591 drug dispensings from 272 328 hospitalizations). We investigated 6 drugs from the original CERT paper and an additional 47 drugs. We benchmarked results against a reference standard that we created from UpToDate 2015. RESULTS: The original CERT algorithm applied to all 53 drugs and 44 laboratory abnormalities yielded a positive predictive value (PPV) and sensitivity of 50.3% and 54.1%, respectively. By raising the minimum number of cases for each drug-laboratory abnormality pair from 2 to 400, the PPV and sensitivity increased to 53.9% and 67.2%, respectively. This post hoc variation, named CERT400, performed particularly well for drug-induced hepatic and renal toxicities. DISCUSSION: We have demonstrated that the CERT algorithm can be applied across national boundaries. One modification (CERT400) was able to identify adverse drug reaction signals from laboratory data with reasonable PPV and sensitivity, which indicates potential utility as a supplementary pharmacovigilance tool

Examining the perceptions and factors influencing eating habits in Singapore

The purpose of this study is to explore the perceptions of healthy eating habits in Singapore, and to identify factors, promoters and barriers affecting eating habits in Singapore. This is a cross-sectional study in which participants completed an online survey. The survey consisted of six sections: (A) Demographics, (B) Perceptions of healthy eating, (C) Actual eating habits, (D) Factors influencing eating behavior, (E) Promoters of healthy eating, and (F) Barriers faced in eating healthy. The survey was conducted between February and March 2011. Participants had to be Singaporeans aged 18 to 65 years old. A total of 114 respondents participated in the survey, of which 100 met the inclusion criteria. When asked to describe a healthy diet, the top phrases listed by respondents were vegetables/greens/salads (57%), less fats/oils (55%), eating a balanced diet/eating in moderation/eating a variety of foods (54%), fruits (45%), and less salt (22%). An overwhelming 98% of respondents reported knowing what a healthy diet is, but only 59% felt their diet is healthy enough. Encouragingly, 63% of respondents felt the need to change their eating habits. Taste consistently emerged as the top factor influencing eating habits, while to stay healthy was the most important reason for respondents to eat healthy. As for barriers, respondents felt that eating healthy is difficult because it is easier to find unhealthy food around (90%), many of the local dishes we are used to are unhealthy (87%) and healthy options are limited where I dine (70%). Our findings reveal that the perceptions of a healthy diet are generally similar to that conveyed by the Dietary Guidelines for Adult Singaporeans, indicating that these guidelines are having some impact. However, actual eating habits suggest that more needs to be done to translate knowledge into action. Future programs to promote healthy eating need to address the importance of taste, as well as the perceived unavailability of healthy foods, in order to have greater success

Towards human–machine collaboration in creating an evaluation corpus for adverse drug events in discharge summaries of electronic medical records

10.1016/j.bdr.2016.04.001Big Data Research437-4

Phenotyping Diabetes Mellitus on Aggregated Electronic Health Records from Disparate Health Systems

Background: Identifying patients with diabetes mellitus (DM) is often performed in epidemiological studies using electronic health records (EHR), but currently available algorithms have features that limit their generalizability. Methods: We developed a rule-based algorithm to determine DM status using the nationally aggregated EHR database. The algorithm was validated on two chart-reviewed samples (n = 2813) of (a) patients with atrial fibrillation (AF, n = 1194) and (b) randomly sampled hospitalized patients (n = 1619). Results: DM diagnosis codes alone resulted in a sensitivity of 77.0% and 83.4% in the AF and random hospitalized samples, respectively. The proposed algorithm combines blood glucose values and DM medication usage with diagnostic codes and exhibits sensitivities between 96.9% and 98.0%, while positive predictive values (PPV) ranged between 61.1% and 75.6%. Performances were comparable across sexes, but a lower specificity was observed in younger patients (below 65 versus 65 and above) in both validation samples (75.8% vs. 90.8% and 60.6% vs. 88.8%). The algorithm was robust for missing laboratory data but not for missing medication data. Conclusions: In this nationwide EHR database analysis, an algorithm for identifying patients with DM has been developed and validated. The algorithm supports quantitative bias analyses in future studies involving EHR-based DM studies

Maritime Interdiction Operations in Logistically Barren Environments

Includes supplementary materialThis report contains analysis that shows that existing technology exists to improve Maritime Interdiction Operations (MIO) by approximately 30%. Furthermore, analysis contained herein will aid MIO planning for future operations. Since MIOs are an inherently dangerous, but necessary activity with far reaching implications to theater political and economic dynamics, this improvement is of great interest. MIO is a Naval solution to the problems of smuggling weapons, explosives, people and narcotics. MIO, when employed correctly has the potential to save lives and limit economic/political damage.N

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo