المؤلفون: Jennifer A. Pacheco, Luke V. Rasmussen, Ken Wiley, Thomas Nate Person, David J. Cronkite, Sunghwan Sohn, Shawn Murphy, Justin H. Gundelach, Vivian Gainer, Victor M. Castro, Cong Liu, Frank Mentch, Todd Lingren, Agnes S. Sundaresan, Garrett Eickelberg, Valerie Willis, Al’ona Furmanchuk, Roshan Patel, David S. Carrell, Yu Deng, Nephi Walton, Benjamin A. Satterfield, Iftikhar J. Kullo, Ozan Dikilitas, Joshua C. Smith, Josh F. Peterson, Ning Shang, Krzysztof Kiryluk, Yizhao Ni, Yikuan Li, Girish N. Nadkarni, Elisabeth A. Rosenthal, Theresa L. Walunas, Marc S. Williams, Elizabeth W. Karlson, Jodell E. Linder, Yuan Luo, Chunhua Weng, WeiQi Wei

المصدر: Scientific Reports, Vol 13, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract The electronic Medical Records and Genomics (eMERGE) Network assessed the feasibility of deploying portable phenotype rule-based algorithms with natural language processing (NLP) components added to improve performance of existing algorithms using electronic health records (EHRs). Based on scientific merit and predicted difficulty, eMERGE selected six existing phenotypes to enhance with NLP. We assessed performance, portability, and ease of use. We summarized lessons learned by: (1) challenges; (2) best practices to address challenges based on existing evidence and/or eMERGE experience; and (3) opportunities for future research. Adding NLP resulted in improved, or the same, precision and/or recall for all but one algorithm. Portability, phenotyping workflow/process, and technology were major themes. With NLP, development and validation took longer. Besides portability of NLP technology and algorithm replicability, factors to ensure success include privacy protection, technical infrastructure setup, intellectual property agreement, and efficient communication. Workflow improvements can improve communication and reduce implementation time. NLP performance varied mainly due to clinical document heterogeneity; therefore, we suggest using semi-structured notes, comprehensive documentation, and customization options. NLP portability is possible with improved phenotype algorithm performance, but careful planning and architecture of the algorithms is essential to support local customizations.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/9c81a942e0f84bc7870a1d35de1a798aTest

المؤلفون: Jordan R Kuiper, Annemarie G Hirsch, Karen Bandeen-Roche, Agnes S Sundaresan, Bruce K Tan, Robert C Kern, Robert P Schleimer, Brian S Schwartz

المصدر: PLoS ONE, Vol 15, Iss 6, p e0235432 (2020)

مصطلحات موضوعية: Medicine, Science

الوصف: Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM? (2) Should nasal cavity opacification be included in scoring? (3) How should location-specific scores be utilized? (4) If location-specific scores are summed, what should be the cutoff? (5) Are associations of opacification with symptoms observed when using different measurement approaches? We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/e4c55f0247e943258c0c6ac22b51759aTest

المؤلفون: Thomas J Ferro, James M Pitcavage, Wendy Y. Cheng, Rinat Ariely, Agnes S. Sundaresan, Ruchir Parikh, Jasmina I. Ivanova, Luke Schmerold

المصدر: Allergy and Asthma Proceedings. 40:21-31

مصطلحات موضوعية: Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Comorbidity, Placebo, 01 natural sciences, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Ambulatory care, Internal medicine, Ambulatory Care, medicine, Electronic Health Records, Humans, Immunology and Allergy, Public Health Surveillance, Anti-Asthmatic Agents, Metered Dose Inhalers, 0101 mathematics, Child, Aged, Asthma, Inhalation, business.industry, Patient Selection, Inhaler, 010102 general mathematics, General Medicine, Odds ratio, Middle Aged, medicine.disease, Treatment Outcome, 030228 respiratory system, Cohort, Female, business

الوصف: Background: Asynchrony, or lack of coordination between inhalation and actuation when using a pressurized metered-dose inhaler (MDI), could theoretically impact the delivery of inhaled medications and treatment efficacy. Objective: To assess the real-world association between asynchrony and clinical outcomes among patients with asthma who receive controller therapy delivered by MDIs. Methods: A cohort of patients was assembled via electronic health records. The patients were aged ≥12 years, with one or more documentations of an asthma diagnosis, no diagnosis of chronic obstructive pulmonary disease, and two or more prescriptions for an inhalation aerosol corticosteroid alone or with long-acting beta-2-agonist delivered via MDI. Their inhaler technique, demonstrated by using a placebo MDI, was evaluated at a clinic visit by study nurses who used a standardized 10-step checklist. Asynchrony was defined as any gap in timing between inhalation and actuation. Clinical outcomes were assessed via electronic health records during the 6 months before the clinic visit and were compared between patients with and patients without asynchrony by using multivariable regression analyses adjusted for age, gender, asthma severity proxy, and baseline comorbidities. Results: Of the total 254 eligible patients, mean age of 49.3 years, 90 males (35.4%), 32 (12.6%) had asynchrony. Patients with asynchrony had higher odds of an asthma exacerbation (adjusted odds ratio, 2.99; p = 0.009), and lower odds of risk domain asthma control (adjusted odds ratio, 0.41; p = 0.04) compared with patients without asynchrony. Conclusion: This study provided real-world evidence that asynchrony in MDI use among patients with asthma who were treated with controller MDIs was associated with clinical burden in terms of asthma exacerbations and control.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::91f517f729730af5ca24908d78d358c0Test
https://doi.org/10.2500/aap.2019.40.4192Test

المؤلفون: Catherine Stanhope, Marcus M. Soliai, Andréanne Morin, Jordan R. Kuiper, Carole Ober, Annemarie G. Hirsch, Brian S. Schwartz, Jayant M. Pinto, Agnes S. Sundaresan

المصدر: International Forum of Allergy & Rhinology

مصطلحات موضوعية: business.industry, Chronic rhinosinusitis, Rhinosinusitis, Statistics, Genome-wide association study, Disease, Research Note, Otorhinolaryngology, Chronic Rhinosinusitis, Immunology, Chronic Disease, Immunology and Allergy, Medicine, Humans, Stage (cooking), Sinusitis, business, Mucosal immunity, Immunity, Mucosal, Genome-Wide Association Study, Rhinitis, Research Notes

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3a74bbbf758c496c21ecda03c36ca5e3Test
https://pubmed.ncbi.nlm.nih.gov/33393196Test

المؤلفون: Robert C. Kern, Agnes S. Sundaresan, Jordan R. Kuiper, Bruce K. Tan, Robert P. Schleimer, Brian S. Schwartz, Karen Bandeen-Roche, Annemarie G. Hirsch

المصدر: PLoS ONE
PLoS ONE, Vol 15, Iss 6, p e0235432 (2020)

مصطلحات موضوعية: Nasal cavity, Male, Pulmonology, Medical Doctors, Health Care Providers, Respiratory System, Social Sciences, Pathology and Laboratory Medicine, Severity of Illness Index, Diagnostic Radiology, 0302 clinical medicine, Allergies, Medicine and Health Sciences, Psychology, Longitudinal Studies, Medical Personnel, Young adult, 030223 otorhinolaryngology, Tomography, Sinus (anatomy), Rhinitis, Aged, 80 and over, Multidisciplinary, Allergic Diseases, Headaches, Radiology and Imaging, Middle Aged, Smell, Professions, medicine.anatomical_structure, Hay fever, Medicine, Female, Sensory Perception, Radiology, Anatomy, Nasal Cavity, Research Article, Adult, Allergic Rhinitis, medicine.medical_specialty, Imaging Techniques, Science, Immunology, Neuroimaging, Research and Analysis Methods, 03 medical and health sciences, Young Adult, Signs and Symptoms, Diagnostic Medicine, Physicians, Severity of illness, medicine, otorhinolaryngologic diseases, Humans, Clinical significance, Sinusitis, Migraine, Asthma, Aged, Inflammation, business.industry, Biology and Life Sciences, Rhinology, medicine.disease, Computed Axial Tomography, Health Care, 030228 respiratory system, Otorhinolaryngology, Chronic Disease, People and Places, Nasal Diseases, Population Groupings, Clinical Immunology, Clinical Medicine, business, Tomography, X-Ray Computed, Neuroscience

الوصف: Chronic rhinosinusitis (CRS) is a prevalent condition. Clinical diagnosis requires subjective evidence (i.e. symptoms) and objective evidence of inflammation (e.g. sinus computed tomography [CT]). Few studies have assessed differences in common CT scoring approaches for CRS, the Lund-Mackay (LM) system and its modified version (mLM); none in a general population sample. The aims of this study were to answer the following: (1) Is mLM superior to LM? (2) Should nasal cavity opacification be included in scoring? (3) How should location-specific scores be utilized? (4) If location-specific scores are summed, what should be the cutoff? (5) Are associations of opacification with symptoms observed when using different measurement approaches? We scored sinus CTs using LM and mLM from 526 subjects selected from a larger CRS study. Exploratory factor analysis (EFA) assessed similarity of mLM and LM. Latent class analysis (LCA) identified subgroups of sinus opacification patterns. Factors associated with group membership and relations with nasal and sinus symptoms (NSS) guided clinical relevance. EFA suggested no differences between LM and mLM, or after addition of nasal cavity opacification. LCA identified three opacification groups: no/mild, localized, and diffuse. Males were 2.7x more likely to have diffuse opacification than females, as were those with asthma or hay fever. A LM cutoff of 3 had similar performance to the currently used 4. Diffuse opacification was associated with nasal blockage and smell loss. Differing patterns of opacification may be clinically relevant, improving measurement of objective evidence in studies of CRS and sinus diseases.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::393a7d73f9fed9e56c2e8445f26ac86eTest
https://pubmed.ncbi.nlm.nih.gov/32598351Test

المؤلفون: Robert C. Kern, Cara Nordberg, Agnes S. Sundaresan, Thomas L. Kennedy, Bruce K. Tan, Robert P. Schleimer, Jordan R. Kuiper, Annemarie G. Hirsch, Joseph Scott Greene, Brian S. Schwartz, Jayant M. Pinto, Karen Bandeen-Roche

المصدر: Allergy

مصطلحات موضوعية: 0301 basic medicine, Adult, Male, medicine.medical_specialty, Adolescent, Chronic rhinosinusitis, Immunology, Population, Sinus inflammation, Logistic regression, Article, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Internal medicine, Epidemiology, Paranasal Sinuses, medicine, otorhinolaryngologic diseases, Immunology and Allergy, Humans, Sinusitis, education, Sinus (anatomy), Aged, Rhinitis, Aged, 80 and over, Inflammation, education.field_of_study, business.industry, Guideline, Middle Aged, Pennsylvania, medicine.disease, 030104 developmental biology, medicine.anatomical_structure, 030228 respiratory system, Migraine, Chronic Disease, Female, business

الوصف: BACKGROUND: Chronic rhinosinusitis (CRS) epidemiology has been largely studied using symptom-based case definitions, without assessment of objective sinus findings. OBJECTIVE: To describe radiologic sinus opacification and the prevalence of CRS, defined by the co-occurrence of symptoms and sinus opacification, in a general population-based sample. METHODS: We collected questionnaires and sinus CT scans from 646 participants selected from a source population of 200,769 primary care patients. Symptom status (CRS(S)) was based on guideline criteria and objective radiologic inflammation (CRS(O)) was based on the Lund-Mackay (L-M) score using multiple L-M thresholds for positivity. Participants with symptoms and radiologic inflammation were classified as CRS(S+O). We performed negative binomial regression to assess factors associated with L-M score and logistic regression to evaluate factors associated with CRS(S+O). Using weighted analysis, we calculated estimates for the source population. RESULTS: The proportion of women with L-M scores greater than or equal to three, four, or six (CRS(O)) was 11.1%, 9.9%, and 5.7%, respectively, and 16.1%, 14.6%, and 8.7% among men. The respective proportion with CRS(S+O) was 1.7%, 1.6%, and 0.45% among women and 8.8%, 7.5%, and 3.6% among men. Men had higher odds of CRS(S+O) compared to women. A greater proportion of men (vs. women) had any opacification in the frontal, anterior ethmoid, and sphenoid sinuses. CONCLUSION: In a general population-based sample in Pennsylvania, sinus opacification was more common among men than in women and opacification occurred in different locations by sex. Male sex, migraine headache, and prior sinus surgery were associated with higher odds of CRS(S+O).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ba233113d5acf236020c07650b44abebTest
https://europepmc.org/articles/PMC7176524Test/

المؤلفون: Joy Reynolds, Agnes S. Sundaresan, H. Lester Kirchner, Gargi Schneider

المصدر: Applied Clinical Informatics

مصطلحات موضوعية: Male, Population, Problem list, clinical research informatics, Health Informatics, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cohen's kappa, Health Information Management, system improvement, 030225 pediatrics, Electronic Health Records, Humans, Medicine, Medical diagnosis, education, Retrospective Studies, education.field_of_study, business.industry, Medical record, Emergency department, medicine.disease, Asthma, Confidence interval, Computer Science Applications, disease management, allergy and immunology, 030228 respiratory system, Female, Electronic data, Medical emergency, Emergency Service, Hospital, clinical data management, business, Algorithms, Research Article

الوصف: Background Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome. Objective We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population. Methods We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset. Results There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms. Conclusion We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::45a6e6fa4397598354fbae15fb802af6Test
https://doi.org/10.1055Test/s-0038-1666994

المؤلفون: Jordan R. Kuiper, Robert C. Kern, Bruce K. Tan, Robert P. Schleimer, Agnes S. Sundaresan, Annemarie G. Hirsch, Karen Bandeen-Roche, Brian S. Schwartz

المصدر: Journal of occupational and environmental medicine. 61(8)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Constitutional symptoms, Chronic rhinosinusitis, Efficiency, Article, 03 medical and health sciences, Indirect costs, 0302 clinical medicine, Cost of Illness, Epidemiology, Absenteeism, Nose Diseases, medicine, Humans, Medical diagnosis, Sinus (anatomy), Asthma, Aged, business.industry, Public Health, Environmental and Occupational Health, Middle Aged, Pennsylvania, Presenteeism, medicine.disease, 030210 environmental & occupational health, Exploratory factor analysis, medicine.anatomical_structure, Cross-Sectional Studies, Physical therapy, Female, Self Report, business

الوصف: OBJECTIVE: Evaluate associations of nasal and sinus and related symptoms, as well as selected health conditions which produce those symptoms, with total lost productive time (LPT) at work in the past two weeks. METHODS: We used a cross-sectional analysis of 2402 currently working subjects. Self-reported physician diagnoses, condition statuses measured with standardized instruments, and symptom-based factor scores from an exploratory factor analysis were used in survey weighted log-binomial regression. RESULTS: Pain and pressure, nasal blockage and discharge, and asthma and constitutional symptom factor scores as well as self-reported allergic rhinitis were associated with higher total LPT. Individuals who met operationalized criteria for multiple health conditions, especially chronic Rhinosinusitis, had the greatest total LPT. CONCLUSIONS: Better management of these symptoms, and awareness of how they impact an individual’s ability to perform job-functions in the workplace, could improve overall productivity.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0e4cd7d0561ae98b360fd31659c3d0ccTest
https://pubmed.ncbi.nlm.nih.gov/31205204Test

المؤلفون: Jordan R. Kuiper, Robert C. Kern, Brian S. Schwartz, M. Cole, Karen Bandeen-Roche, Annemarie G. Hirsch, Agnes S. Sundaresan, Bruce K. Tan, Robert P. Schleimer

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Chronic rhinosinusitis, Immunology, Severity of Illness Index, Article, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Surveys and Questionnaires, medicine, Immunology and Allergy, Humans, Longitudinal Studies, Time point, Sinusitis, 030223 otorhinolaryngology, Cluster analysis, Symptom measurement, Asthma, Aged, Rhinitis, Flu symptoms, business.industry, Middle Aged, medicine.disease, Exploratory factor analysis, 030228 respiratory system, Smell loss, Chronic Disease, Female, business, Factor Analysis, Statistical

الوصف: Background Sinonasal symptoms are common and can have several underlying causes. When symptoms occur in specified patterns lasting 3 months or more they meet criteria for chronic rhinosinusitis (CRS). Approaches to CRS symptom measurement do not specify how to measure symptoms and treat specified sinonasal symptoms as generally interchangeable, suggesting that such symptoms should cluster on 1 or 2 latent factors. Methods We used questionnaire responses to 37 questions on the presence, severity, bother, and frequency of cardinal sinonasal and related symptoms lasting 3 months, from 3535 subjects at 3 time points over 16 months. We completed 5 exploratory factor analyses (EFA) to identify symptom clustering, 1 for each time point and 2 for the differences between adjacent questionnaires. The baseline EFA was used to provide factor scores that were described longitudinally and examined by CRS status. Results Five EFAs identified the same 5 factors (blockage and discharge, pain and pressure, asthma and cold/flu symptoms, smell loss, and ear and eye [mainly allergy] symptoms), with clustering determined by symptom frequency, severity, and degree of bother. Responses to individual questions showed changes over time but when combined into factor scores showed less longitudinal change. All symptom factor scores were progressively higher from never to past to current CRS status. Conclusions Although the current approaches to symptom characterization in CRS imply a single underlying latent construct, our results suggest that there are at least 3 latent constructs relevant to CRS. Further studies are needed to evaluate whether these clusters have identifiable underlying pathobiologies.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::54153109a4b5b13be1c207cfeb273e66Test
https://europepmc.org/articles/PMC6151861Test/

المؤلفون: Agnes S. Sundaresan, Jordan R. Kuiper, Robert C. Kern, Annemarie G. Hirsch, Bruce K. Tan, Robert P. Schleimer, Walter F. Stewart, Karen Bandeen-Roche, Brian S. Schwartz

مصطلحات موضوعية: Male, medicine.medical_specialty, Exacerbation, Immunology, Population, Logistic regression, Severity of Illness Index, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Surveys and Questionnaires, Epidemiology, medicine, otorhinolaryngologic diseases, Prevalence, Immunology and Allergy, Humans, Longitudinal Studies, Sinusitis, 030223 otorhinolaryngology, education, Sinus (anatomy), Asthma, Rhinitis, education.field_of_study, business.industry, medicine.disease, medicine.anatomical_structure, 030228 respiratory system, Population Surveillance, Chronic Disease, Disease Progression, Hay fever, Female, Symptom Assessment, business, Body mass index

الوصف: BACKGROUND: Nasal and sinus symptoms (NSS) are common to many health conditions, including chronic rhinosinusitis (CRS). Few studies have investigated the occurrence and severity of, and risk factors for, acute exacerbations of NSS (AENSS) by CRS status (current, past, or never met European Position Paper on Rhinosinusitis [EPOS] criteria for CRS). METHODS: Four seasonal questionnaires were mailed to a stratified random sample of Geisinger primary care patients. Logistic regression was used to identify individual characteristics associated with AENSS occurrence and severity by CRS status (current long-term, current recent, past, never) using EPOS subjective symptoms-only (EPOS(S)) CRS criteria. We operationalized three AENSS definitions based on prescribed antibiotics or oral corticosteroids, symptoms, and symptoms with purulence. RESULTS: Baseline and at least one follow-up questionnaires were available from 4,736 subjects. Self-reported NSS severity with exacerbation was worst in the current long-term CRS group. AENSS was common in all subgroups examined and generally more common among those with current EPOS(S) CRS. Seasonal prevalence of AENSS differed by AENSS definition and CRS status. Associations of risk factors with AENSS differed by definition, but CRS status, body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted AENSS. CONCLUSIONS: In this first longitudinal, population-based study of three AENSS definitions, NSS and AENSS were both common, sometimes severe, and differed by EPOS(S) CRS status. Contrasting associations of risk factors for AENSS by the different definitions suggest a need for a standardized approach to definition of AENSS.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::33e4f938ec46120554860947d174dfdfTest
https://europepmc.org/articles/PMC5993580Test/