Patient Dietary Supplements Use: Do Results from Natural Language Processing of Clinical Notes Agree with Survey Data?

There is widespread use of dietary supplements, some prescribed but many taken without a physician's guidance. There are many potential interactions between supplements and both over-the-counter and prescription medications in ways that are unknown to patients. Structured medical records do not adequately document supplement use; however, unstructured clinical notes often contain extra information on supplements.

Identification of colorectal cancer using structured and free text clinical data.

Colorectal cancer incidence has continually fallen among those 50 years old and over. However, the incidence has increased in those under 50. Even with the recent screening guidelines recommending that screening begins at age 45, nearly half of all early-onset colorectal cancer will be missed.

Criticality: A New Concept of Severity of Illness for Hospitalized Children.

Objectives: To validate the conceptual framework of "criticality," a new pediatric inpatient severity measure based on physiology, therapy, and therapeutic intensity calibrated to care intensity, operationalized as ICU care.

Design: Deep neural network analysis of a pediatric cohort from the Health Facts (Cerner Corporation, Kansas City, MO) national database.

Setting: Hospitals with pediatric routine inpatient and ICU care.

Detecting Secular Trends in Clinical Treatment through Temporal Analysis.

Medical treatments change over time for multiple reasons, including introduction of new treatments, availability of new scientific evidence, change in institutional guidelines, and market efforts by pharmaceutical and medical device companies. Monitoring and analyzing these secular trends will also inform the evaluation of evidence based practice as well as outcome research. Using a large national clinical dataset from the United States Veterans Health Administration (VHA), we measured the change in prevalence of all diseases, medications, and procedures by year from 2001 to 2014.

Identification and Use of Frailty Indicators from Text to Examine Associations with Clinical Outcomes Among Patients with Heart Failure.

Frailty is an important health outcomes indicator and valuable for guiding healthcare decisions in older adults, but is rarely collected in a quantitative, systematic fashion in routine healthcare. Using a cohort of 12,000 Veterans with heart failure, we investigated the feasibility of topic modeling to identify frailty topics in clinical notes. Topics were generated through unsupervised learning and then manually reviewed by an expert.

The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study.

Background: Shared decision-making can improve patient satisfaction and outcomes. To participate in shared decision-making, patients need information about the potential risks and benefits of treatment options. Our team has developed a novel prototype tool for shared decision-making called hearts like mine (HLM) that leverages EHR data to provide personalized information to patients regarding potential outcomes of different treatments.

Automated Learning of Temporal Expressions.

Clinical notes contain important temporal information that are critical for making clinical diagnosis and treatment as well as for retrospective analyses. Manually created regular expressions are commonly used for the extraction of temporal information; however, this can be a time consuming and brittle approach. We describe a novel algorithm for automatic learning of regular expressions in recognizing temporal expressions.

Pediatric hepatopulmonary syndrome is seen with polysplenia/interrupted inferior vena cava and without cirrhosis.

Hepatopulmonary syndrome (HPS) is a triad of liver dysfunction, hypoxemia, and intrapulmonary vascular dilatation. We describe the prevalence and clinical features of HPS at a pediatric liver transplant center. Patients referred to Children's Healthcare of Atlanta/Emory University transplant program from February 1999 to May 2005 were reviewed.

Renal artery pseudoaneurysm secondary to blunt trauma treated with microcoil embolization.

Background: Renal artery pseudoaneurysms are rarely described sequelae of blunt abdominal trauma. Interventional radiological advances have allowed such lesions to be managed nonoperatively.

Methods: The authors review the presentation, diagnostic evaluation, and hospital course of an 11-year-old girl who developed a right renal artery pseudoaneurysm 14 days after blunt abdominal trauma.

Endoluminal versus open treatment of descending thoracic aortic aneurysms.

Purpose: This report describes the authors' initial experience with the Excluder thoracic endoprosthesis (W. L. Gore and Associates, Inc, Flagstaff, Ariz) and the thoracic Talent endoprosthesis (Medtronic AVE, Sunrise, Fla) and their safety and efficacy in the primary endovascular repair of descending thoracic aortic aneurysms (TAAs).