Correlation of the Epworth Sleepiness Scale and Sleep-Disordered Breathing in Men and Women.

STUDY OBJECTIVES: To compare Epworth Sleepiness Scale (ESS) scores of men and women and determine if there is a correlation with sleep-disordered breathing (SDB) based on subsequent polysomnography (PSG). METHODS: Consecutive adult patients were identified who completed ESS and PSG at Mayo Clinic in Rochester, Minnesota, between January 1, 2013, and January 31, 2015. Apnea-hypopnea index (AHI) ≥ 5 events/h was classified as presence of SDB, and increasing values represented greater severity. RESULTS: Among 6,593 patients with valid ESS scores and timely subsequent PSG, 42% were women. Mean (standard deviation [SD]) age of women was 56.2 (15.2) years; men, 58.5 (15.1) years. Mean (SD) ESS score was 9.5 (5.4) for women and 9.5 (5.3) for men. SDB was present in 83.6% of men and 68.3% of women. Mean (SD) AHI of men was 25.9 (26.7) events/h; women, 16.1 (22.4) events/h (P < .001). Each unit increase in ESS score of men was associated with a 0.51-unit increase in AHI (P < .001); women had a 0.16-unit associated increase (P = .04) (effect ratio, threefold greater for men). PSG demonstrated that women had greater sleep efficiency, less respiratory effort-related arousals, and less hypoxemia (all P < .001). Among women, ESS did not correlate with presence of SDB or mild to moderate SDB. There was a small association in women with severe SDB. CONCLUSIONS: ESS is not correlated with SDB at mild to moderate levels in women and has a smaller association than in men with severe SDB. Further work is necessary to understand sex-specific differences in patients with SDB.

Comparison of SNOMED CT versus Medcin terminology concept coverage for mild Traumatic Brain Injury.

BACKGROUND: Traumatic Brain Injury (TBI) is a "signature" injury of the current wars in Iraq and Afghanistan. Structured electronic data regarding TBI findings is important for research, population health and other secondary uses but requires appropriate underlying standard terminologies to ensure interoperability and reuse. Currently the U.S. Department of Veterans Affairs (VA) uses the terminology SNOMED CT and the Department of Defense (DOD) uses Medcin. METHODS: We developed a comprehensive case definition of mild TBI composed of 68 clinical terms. Using automated and manual techniques, we evaluated how well the mild TBI case definition terms could be represented by SNOMED CT and Medcin, and compared the results. We performed additional analysis stratified by whether the concepts were rated by a TBI expert panel as having High, Medium, or Low importance to the definition of mild TBI. RESULTS: SNOMED CT sensitivity (recall) was 90% overall for coverage of mild TBI concepts, and Medcin sensitivity was 49%, p < 0.001 (using McNemar's chi square). Positive predictive value (precision) for each was 100%. SNOMED CT outperformed Medcin for concept coverage independent of import rating by our TBI experts. DISCUSSION: SNOMED CT was significantly better able to represent mild TBI concepts than Medcin. This finding may inform data gathering, management and sharing, and data exchange strategies between the VA and DOD for active duty soldiers and veterans with mild TBI. Since mild TBI is an important condition in the civilian population as well, the current study results may be useful also for the general medical setting.

The Health Archetype Language (HAL-42): interface considerations.

In this manuscript we report an evaluation of the reliability of clinical research rules creation by multiple clinicians using the Health Archetype Language (HAL-42) and user interface. HAL-42 is a language which allows real time epidemiological inquiry using automatically derived clinical encodings with any health Ontology. This evaluation used SNOMED CT as the underlying Ontology. The inquiries were performed on a population of 17,731 patients whose 50,000 clinical records have all been fully encoded in SNOMED CT. Four subject matter experts (SMEs) were asked independently to encode and run 10 rules/studies. The inter-rater agreement was 74.8% (p=0.6526) with a Kappa statistic of 0.49217 (p=0.5722). The ten rules were divided into three easy rules, four moderate and three complex rules. There was no significant difference in the SME's agreement when representing easy and complex rules (p=0.6243). We conclude that although the usability of the HAL-42 language is usable enough to achieve reasonable inter-rater reliability, some training will be necessary to reach high levels of reliability for ad hoc queries. We also conclude that SMEs are just as competent to perform complex queries as easy queries of ontologically indexed clinical data.

NLP-based identification of pneumonia cases from free-text radiological reports.

Radiological reports are a rich source of clinical data which can be mined to assist with biosurveillance of emerging infectious diseases. In addition to biosurveillance, radiological reports are an important source of clinical data for health service research.Pneumonias and other radiological findings on chest x ray or chest computed tomography (CT) are one type of relevant finding to both biosurveillance and health services research. In this study we examined the ability of a Natural Language Processing system to accurately identify pneumonias and other lesions from within free text radiological reports. The system encoded the reports in the SNOMED CT Ontology and then a set of SNOMED CT based rules were created in our Health Archetype Language aimed at the identification of these radiological findings and diagnoses. The encoded rule was executed against the SNOMED CT encodings of the radiological reports. The accuracy of the reports was compared with a Clinician review of the Radiological Reports. The accuracy of the system in the identification of pneumonias was high with a Sensitivity (recall) of 100%, a specificity of 98%, and a positive predictive value (precision) of 97%. We conclude that SNOMED CT based computable rules are accurate enough for the automated biosurveillance of pneumonias from radiological reports.

Using natural language processing for identification of pneumonia cases from clinical records of patients with serologically proven influenza.

The purpose of this study was to determine whether influenza vaccination protects against pneumonia in patients who develop influenza. By parsing a data set of records of 1455 patients with serologically proven influenza using SNOMED CT we found that of the vaccinated patients 19.3% developed pneumonia and of the unvaccinated 20.7%. These data suggest that influenza vaccine does not prevent pneumonias in patients who develop influenza despite immunization with influenza vaccine.

Whole record surveillance is superior to chief complaint surveillance for predicting influenza.

Matched records of positive and negative influenza cases were parsed with a Natural Language Processor, the Multi-threaded Clinical Vocabulary Server (MCVS). Output was coded into SNOMED-CT reference terminology and compared to the SNOMED case definition of influenza. Odds ratios for each element of the influenza case definition by each section of the record were used to generate ROC curves. C-statistics showed that whole record surveillance was superior to chief complaint surveillance for predicting influenza.

Case report: acute spontaneous Achilles tendon rupture in a patient with giant cell arteritis.

We report a case of a 69-yr-old previously healthy man with acute spontaneous Achilles tendon rupture and severe tendonitis, which occurred after 2 weeks of steroid therapy for newly diagnosed giant cell arteritis. The Achilles tendon rupture was treated conservatively and the tendonitis resolved incrementally with steroid dose reduction. The patient made a complete recovery. In view of the widespread use of steroids in practice, this novel case presentation has important clinical implications. The tendon rupture early in the course of high-dose steroid therapy expands the understanding of this adverse reaction, which was previously reported only with long-term steroid therapy. The severe tendonitis responded to steroid therapy reduction suggesting a dose correlation. This report adds to a sole previous report of a spontaneous Achilles tendon rupture associated with giant cell arteritis.

Perioperative evaluation and management of the patient with endocrine dysfunction.

Whenever possible, endocrine disorders should be identified and evaluated prior to surgery. A plan for perioperative management of diabetes should be based on the type of diabetes, what diabetes medications are taken, the status of diabetes control, and what type of surgery is planned. Perioperative management of diabetes must include bedside glucose monitoring. Patients with mild hypothyroidism can safely proceed with elective surgery. Elective surgery should be postponed for patients with moderate or severe hypothyroidism. Patients who have mild hyperthyroidism can undergo elective surgery with preoperative beta blockade. Elective surgery should not be done on patients with moderate or severe hyperthyroidism until they are euthyroid. Patients with pheochromocytoma need to be identified and properly treated before surgery to prevent perioperative cardiovascular complications. Patients who take endogenous steroids should have the status of their HPA axis determined prior to surgery. If the patient is undergoing moderate or major surgical stress and has documented or presumed HPA suppression, then stress doses of steroids should be give perioperatively.