DigitalCommons@KCU (Kansas City Univ.)
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Sensitivity and Specificity of Natural Language Processing Systems for Identification of Hospitalized People Who Use Drugs
Get PDFBackground: People who use drugs (PWUD) often lack access to optimal harm reduction and substance use disorder treatment tools. Tracking the epidemiology of acute care utilization by PWUD is crucial to improving systems of care. Chart reviews and International Classification of Diseases (ICD) codes are the most common systems of identifying hospitalizations of PWUD but are limited by high labor costs and inaccuracy. This study evaluates whether natural language processing (NLP) enhances the sensitivity and specificity of ICD-10 codes in identifying hospitalizations of PWUD.
Methods: We analyzed admissions at Tufts Medical Center between 2018 and 2023. Two NLP tools (Regular Expression and Open Health NLP Toolkit) were developed to identify PWUD and were compared with ICD-10 algorithms. The NLP and ICD-10 algorithms were applied to all admissions, and demographic and hospitalization-related data were extracted. The research team manually reviewed notes written during 790 hospitalizations of PWUD as the gold standard. We calculated sensitivity, specificity, and net reclassification indices.
Results: ICD-10 codes alone demonstrated low sensitivity (43%) but high specificity (99%). Adding NLP systems improved sensitivity up to 94%, though specificity decreased to 46%. Threshold adjustments (eg, notes flagged ≥50%) revealed a trade-off between sensitivity (47%) and specificity (96%). The most practical model-Regular Expression or ICD-10 codes-resulted in a sensitivity of 74% and specificity of 87%.
Conclusions: NLP is an innovative tool that can create functional, cost-effective, and accurate systems of identifying hospitalized PWUD. These findings support further development of NLP technologies to improve health care equity for PWUD
The Role of Exosomes in Medical Dermatology: Literature Review and Update
Get PDFBackground
Exosomes are extracellular vesicles, composed of a phospholipid bilayer, that are primarily derived from stem cells. The contents of exosomes can be incorporated into the tissue in which they are introduced, which presents a unique therapeutic option.
Aims
Exosomes have been investigated as a treatment for a number of medical ailments, but the literature supporting these indications is inconclusive. In addition, much of the study on exosomes and their uses has been recently completed. Thus, this review summarizes the efficacy and implications of exosomes in the treatment of different dermatologic conditions.
Methods
A literature review surrounding the use of exosomes for multiple medical dermatological conditions was conducted. Additionally, we present numerous practical cases in which patients had been treated with exosomes.
Results
Overall, the success of exosomes in treating medical dermatologic conditions demonstrated varying efficacy in the literature, but the preliminary evidence is generally positive. The patient cases also showed satisfactory clinical outcomes but further studies and cases will be necessary to fully characterize the efficacy of exosomes and the ideal modalities for their application, including formulation, mode of distribution, and frequency of treatment.
Conclusions
Exosomes may serve as an effective treatment option for wound healing, reconstruction of skin flaps, radiation dermatitis, acne vulgaris, psoriasis, atopic dermatitis, allergic contact dermatitis, lichen simplex chronicus, vulvar lichen sclerosis, systemic sclerosis, systemic lupus erythematosus, and vitiligo although additional studies are needed to confirm their efficacy and safety
A Rare Case of Rapidly Progressing Merkel Cell Carcinoma
No full textMerkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumor, known for its rapid progression and poor prognosis. It most commonly affects elderly and immunocompromised individuals, with variable clinical presentations that can make diagnosis challenging. MCC is often mistaken for other skin malignancies, such as basal or squamous cell carcinoma, or even benign skin lesions. Early diagnosis is critical to initiate appropriate treatment, typically involving surgery, radiation, and immunotherapy. This report describes a 66-year-old man diagnosed with MCC with regional lymph node involvement. Immunotherapy was started promptly; however, within a year, the disease progressed to the mediastinum, involving the esophagus and trachea, an uncommon site of metastasis. The patient ultimately died in the ICU from respiratory failure. This case highlights the aggressive behavior of MCC and underscores the importance of vigilant follow-up, even after early diagnosis. Once metastasis to the lymph nodes occurs, MCC becomes particularly challenging to manage, especially when it follows an atypical metastatic pattern
Psychiatric Variables and Length of Competency Restoration
No full textIn the United States, waitlists for competency restoration treatment have become extensive and problematic. Many individuals wait up to one year to receive mental health treatment, and the waiting period can involve harsh treatment while incarcerated. While factors such as lack of resources have contributed to this ongoing problem, research has examined other factors that might be contributing. Although inconsistent, previous research has linked certain demographic variables with longer lengths of competency restoration. Furthermore, current literature suggests individuals diagnosed with psychotic disorders take longer to restore competency when compared to individuals diagnosed with affective disorders. However, the existing literature has yet to compare specific symptomology within psychotic diagnoses that may extend lengths of competency restoration. The current study examined the comparison of primary interfering symptomology within psychiatric diagnoses to aid in determining which are associated with longer lengths of competency restoration. A retrospective research design was used, and archival data from an inpatient psychiatric facility was analyzed to compare lengths of competency restoration based on several variables, including gender, race, diagnosis, types of delusions and hallucinations, and level of engagement in treatment services. A multiple regression analysis was conducted to explore the effect of specific demographics and length of stay. Independent samples t-tests were used to examine the relationship between various psychiatric diagnoses, interfering symptoms, and level of engagement in treatment on length of stay. The results of the study suggest individuals diagnosed with a psychotic disorder experience longer lengths of stay iv undergoing competency restoration treatment. Additionally, the level of treatment engagement significantly influenced the length of stay. Limitations of this study include a lack of variability and generalizability within the sample due to archival data gathered from a sole facility. Future research should examine psychiatric variables and length of competency restoration treatment in various settings
Report of the ADEA Task Force on Envisioning and Transforming the Future of Oral Health and Education (TF-ETFOHE)
No full textUnilateral Facial Paralysis With Facial Nerve Enhancement on MRI in a Patient With Guillain-Barré Syndrome: A Case Report
No full textGuillain-Barré syndrome (GBS) represents a spectrum of inflammatory polyradiculoneuropathies. Several variants have been reported with distinct symptom profiles. Cranial nerve involvement is relatively common, but it most often presents as bilateral facial nerve palsy at onset. We describe the case of a 66-year-old man who initially presented with extremity paresthesia that rapidly progressed to leg weakness and hyporeflexia. The diagnosis of GBS was confirmed by cerebrospinal fluid analysis, and he was treated with intravenous immunoglobulin. Following treatment, however, he developed facial hemiplegia, which was associated with facial nerve enhancement on MRI. This case represents one of the few reports of delayed-onset unilateral cranial nerve palsy in GBS, further distinguished by the rare finding of facial nerve enhancement on MRI. Awareness of such uncommon variants is important, as they may influence both morbidity and mortality
The Role of Embodied Cognition in the Neurorehabilitation of Ischemic Stroke: A Systematic Narrative Literature Review
No full textIschemic strokes, the blockage of blood flow to the brain, are the most common type of stroke that affects adults worldwide and is the fifth most common cause of death. Stroke survivors experience physical and cognitive aftermaths, which gravely impact their quality of life and activities of daily living. Current standards for post-stroke treatment highlight the importance of early detection, medication, and neurorehabilitation. Standard neurorehabilitation techniques encompass a multidisciplinary approach involving patients, caregivers, and treatment teams. Although the body and movement are essential for the recovery of stroke, few studies examine how embodied treatments play a role in the neurorehabilitation of post-stroke symptoms. Embodied treatments are based on embodied cognition (EC), a theoretical framework that postulates that the brain works in bidirectional pathways through the connection of the body and mind. Thus, EC treatments focus on how the body and its presence in the environment significantly affect cognition and emotion. Therefore, it is proposed that embodied treatments are beneficial for stroke rehabilitation. Thus, a systematic narrative literature review was utilized to explore the effectiveness and usefulness of embodied treatments in the neurorehabilitation of physical, cognitive, and psychiatric post-stroke symptoms. Treatment effectiveness was operationalized with three tables for each treatment outcome (i.e., physical, cognitive, and psychiatric symptoms). Each table evaluated the studies’ sample, design, methodology, effect sizes, and level of embodiment, as measured with the Level of Embodiment Rubric
Identification of Hidden Lesions of the Popliteal Hiatus Through a Systematic Clinical, MRI and Arthroscopic Assessment
No full textPurpose: The aim of this study was to delineate a systematic clinical, MRI, and arthroscopic approach for evaluating the popliteal hiatus and its associated structures, while also exploring the clinical presentations potentially linked to pathological findings.
Methods: A prospective, cross-sectional study was conducted at two high-volume knee surgery centres. Patients scheduled for arthroscopically assisted knee surgery underwent preoperative evaluation using targeted clinical assessments and MRI examinations, incorporating sagittal, coronal, and sagittal-oblique sequences. A standardised, three-stage arthroscopic exploration of the popliteal hiatus and posterolateral capsular recess was performed, with each structure classified as \u27healthy\u27, \u27injured\u27 or \u27not visible\u27. The diagnostic accuracy of clinical tests and MRI sequences was evaluated in comparison with arthroscopic findings.
Results: In a cohort of 67 patients, systematic arthroscopic evaluation identified pathological findings in the popliteal hiatus and posterolateral capsular recess in 38% of cases. In 20.9% of cases, at least one structure was deemed not visible during arthroscopy. The agreement between MRI and arthroscopic findings varied by sequence, with T2-weighted coronal views demonstrating the highest concordance (79.7%). However, overall kappa values indicated minimal to low agreement. Clinical examinations exhibited low sensitivity but relatively high specificity, with the Figure-4 test and locking symptoms emerging as more reliable clinical indicators.
Conclusions: Systematic arthroscopic exploration of the popliteal hiatus and posterolateral capsular recess revealed a notable incidence of occult pathological findings. MRI showed only moderate concordance with arthroscopy, and clinical examination demonstrated low sensitivity but high specificity
The Role of Osteopathic Manipulative Medicine in Cerebral Palsy: Bridging Treatment Gaps and Enhancing Care
No full textOsteopathic manipulative medicine (OMM) is a hands-on approach utilized by physicians to diagnose, treat, and prevent various conditions through the application of muscle manipulation techniques. It has been applied in managing chronic musculoskeletal (MSK) pain, headaches, migraines, Parkinsonian gait, and psychological conditions such as stress, anxiety, and depression. In our narrative review, we aim to integrate both direct clinical studies of OMM in cerebral palsy (CP) and supportive literature on mechanisms and related conditions. A comprehensive literature search was conducted utilizing PubMed and Google Scholar to identify relevant studies on OMM in CP management. Search strategies were intentionally broad to capture mechanistic, supportive, and clinical evidence. Representative terms included “osteopathic manipulative medicine and cerebral palsy,” “osteopathic treatment and neurological disorders,” and “manual therapy and cerebral palsy.” Additionally, reference lists of relevant articles were manually reviewed to identify additional studies. Overall, we found that integrating OMM into CP management may offer a noninvasive approach to improving MSK function and neuromuscular control while alleviating the emotional and physical challenges, as well as increasing movement to reduce joint contractures associated with the condition. OMM techniques may also help reduce stress, anxiety, and constipation, which are prevalent among CP patients due to the psychological and physiological burdens of the disorder. OMM’s holistic approach has the potential to enhance outcomes for individuals with CP by addressing their multifaceted needs. While further research and advocacy are necessary to fully integrate OMM into mainstream CP management, existing evidence suggests that OMM may improve patient outcomes and quality of life. However, the current evidence has remained somewhat limited