NETIMIS: Dynamic Simulation of Health Economics Outcomes Using Big Data

Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of ‘big data’. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital’s EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com) suitable for visualization of both human-designed and data-mined processes which can then be used for ‘what-if’ analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively ‘deep dive’ into big data

Medicine Posters - 2019

Medicine Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1004/thumbnail.jp

Time Delays in Instituting Thrombolysis in Acute Myocardial Infarction - a Singapore Perspective

The reduction of mortality from acute myocardial infarction has been achieved mainly through the use of thrombolysis. In large scale studies, mortality and the extent of myocardial salvage are directly related to how early thrombolysis or reperfusion is instituted. This study was done to highlight the factors resulting in time delays that need to be targeted for change: (a) Pre-hospital delays (recognition of symptoms suggesting an acute myocardial infarction and the presentation to the A&amp;E Department); (b) Delays that occur within the A&amp;E Department; and (c) Delays after leaving the Accident &amp; Emergency Department. We identified the areas contributing to significant delays in each of these areas with a view of proposing that a subgroup of these patients may be identified for a fast track approach in initiating thrombolysis within the Accident &amp; Emergency Department. </jats:p

Autoimmune Limbic Encephalitis in a Patient with Acute Encephalopathy and Hyponatremia

Acute encephalopathy is a common clinical presentation for hospital admissions. Autoimmune encephalitis is a rare cause of encephalopathy which has increasingly been recognized over the last decade. The detection of various neuronal antibodies has helped diagnose these syndromes, but they have limited availability, mostly in the developed countries. We present a case of a middle-aged female presenting with memory impairment, gait disturbances, and hyponatremia. A clinical diagnosis of autoimmune limbic encephalitis was made based on faciobrachial dystonic seizures, SIADH, and MRI changes 10 days prior to autoantibody titer returned. Prompt treatment with steroids and intravenous immunoglobulin was started with improvement in her neurological symptoms. This case highlights the importance of considering autoimmune encephalitis syndromes in the differential diagnosis of patients with classical neurological presentations and prompt diagnosis and immunotherapy to improve neurological outcomes

Autoimmune Limbic Encephalitis in a Patient with Acute Encephalopathy and Hyponatremia

Acute encephalopathy is a common clinical presentation for hospital admissions. Autoimmune encephalitis is a rare cause of encephalopathy which has increasingly been recognized over the last decade. The detection of various neuronal antibodies has helped diagnose these syndromes, but they have limited availability, mostly in the developed countries. We present a case of a middle-aged female presenting with memory impairment, gait disturbances, and hyponatremia. A clinical diagnosis of autoimmune limbic encephalitis was made based on faciobrachial dystonic seizures, SIADH, and MRI changes 10 days prior to autoantibody titer returned. Prompt treatment with steroids and intravenous immunoglobulin was started with improvement in her neurological symptoms. This case highlights the importance of considering autoimmune encephalitis syndromes in the differential diagnosis of patients with classical neurological presentations and prompt diagnosis and immunotherapy to improve neurological outcomes.</jats:p

Bordetella pertussis serotype of clinical isolates in Sweden during 1970-1995 and influence of vaccine efficacy studies

During the years 1970 to 1995, the serotypes of collected clinical isolates from the different regions of Sweden were examined. Vaccination using whole-cell pertussis vaccine decreased during the year preceding cessation of general vaccination of children in 1979. Although the total number of clinical isolates examined was limited up to 1978 compared to later years, serotype 1, 2, 3 clinical isolates generally predominated. During periodical pertussis outbreaks, serotype 1, 3 strains were isolated, the proportion of which was about equal to that of serotype 1, 2, 3 isolates. Following cessation of general vaccination in 1979, the proportion of both serotypes 1, 2, 3 and 1, 3 isolates gradually diminished, together contributing about 20 percent of the total number of isolates in 1995. Clinical isolates of serotype 1, 2 were identified in the year 1977, just before cessation of general vaccination in Sweden using whole-cell vaccine. Since then, this serotype has gradually increased to over 80 percent of total isolates in 1995, possibly indicating that the use of whole-cell pertussis vaccine was effective against this serotype or that the vaccine influenced serotype expression. Vaccine efficacy studies conducted in Sweden during 1986-87 using one and two-component vaccines (BIKEN) and in 1994-95 using two-component (SmithKline Beecham Pharmaceuticals) and five-component (Connaught Laboratories, Ltd.) vaccines are examined with the object of studying whether the vaccines showed any influence on the different serotypes of B. pertussis causing disease