RESUMEN
Background: Atopic dermatitis (AD) is a chronic skin condition that millions of people around the world live with each day. Performing research studies into identifying the causes and treatment for this disease has great potential to provide benefit for these individuals. However, AD clinical trial recruitment is a non-trivial task due to variance in diagnostic precision and phenotypic definitions leveraged by different clinicians as well as time spent finding, recruiting, and enrolling patients by clinicians to become study subjects. Thus, there is a need for automatic and effective patient phenotyping for cohort recruitment. Objective: Our study aims to present an approach for identifying patients whose electronic health records suggest that they may have AD. Methods: We created a vectorized representation of each patient and trained various supervised machine learning methods to classify when a patient has AD. Each patient is represented by a vector of either probabilities or binary values where each value indicates whether they meet a different criteria for AD diagnosis. Results: The most accurate AD classifier performed with a class-balanced accuracy of 0.8036, a precision of 0.8400, and a recall of 0.7500 when using XGBoost (Extreme Gradient Boosting). Conclusions: Creating an automated approach for identifying patient cohorts has the potential to accelerate, standardize, and automate the process of patient recruitment for AD studies; therefore, reducing clinician burden and informing knowledge discovery of better treatment options for AD.
RESUMEN
OBJECTIVE: Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care). RESEARCH DESIGN AND METHODS: We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report. RESULTS: In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (ß = -0.149; P = 0.393) and MPR values (ß = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant. CONCLUSIONS: In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Trastornos Mentales/epidemiología , Veteranos/estadística & datos numéricos , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , United States Department of Veterans Affairs/organización & administraciónAsunto(s)
Disección/métodos , Mucosa Gástrica/cirugía , Gastroscopía , Cooperación Internacional , Estadificación de Neoplasias , Neoplasias Gástricas/cirugía , Diagnóstico Precoz , Europa (Continente) , Mucosa Gástrica/patología , Humanos , Japón , América del Norte , Reproducibilidad de los Resultados , América del Sur , Neoplasias Gástricas/patologíaRESUMEN
Real-time polymerase chain reaction for human bocavirus (HBoV) was performed in nasopharyngeal aspirate specimens from 166 children over 2 years of age hospitalized for severe asthma exacerbation. Whereas HBoV was detected in 21 of these children (13%), it was found in only 1 of 50 ambulatory children with stable asthma (2%), suggesting a major role of HBoV in acute exacerbations in asthmatic children.