Design of a bi-directional methodology for automated assessment of compliance to continuous application of clinical guidelines, and its evaluation in the type 2 diabetes domain.

We introduce a new approach for automated guideline-based-care quality assessment, the bidirectional knowledge-based assessment of compliance (BiKBAC) method, and the DiscovErr system, which implements it. Our methodology compares the guideline's Asbru-based formal representation, including its intentions, with the longitudinal medical record, using a top-down and bottom-up approach. Partial matches are resolved using fuzzy temporal logic.

A community-of-practice-based evaluation methodology for knowledge intensive computational methods and its application to multimorbidity decision support.

Objective: The study has dual objectives. Our first objective (1) is to develop a community-of-practice-based evaluation methodology for knowledge-intensive computational methods. We target a whitebox analysis of the computational methods to gain insight on their functional features and inner workings.

Do patients read emails from their physician containing tips on improving lifestyle habits? A pilot study.

Introduction: Healthcare providers and organizations occasionally use electronic messages to provide information to patients. There is insufficient data on whether patients actually read the emails they receive. In this study, we aimed to assess the cooperation of patients in reading multiple information pages sent over 6 months from their diabetologist via email.

A Large-Scale Observational Analysis of Social Media Data Reveals Major Public Misperception of the Attainability of Drastic Weight Loss by Dieting.

Introduction: Diet forums in social media websites provide an opportunity to glimpse the experience of different weight loss diet strategies reported by tens of thousands of individuals.

Methods: We analyzed all postings with weight information from the six major Reddit weight loss diet forums ("subreddits") as reported by forum participants.

Results: Data were collected from January 2011 to April 2020 from all 55,900 users posting weight information.

Electroencephalography functional connectivity-A biomarker for painful polyneuropathy.

Background And Purpose: Advanced analysis of electroencephalography (EEG) data has become an essential tool in brain research. Based solely on resting state EEG signals, a data-driven, predictive and explanatory approach is presented to discriminate painful from non-painful diabetic polyneuropathy (DPN) patients.

Methods: Three minutes long, 64 electrode resting-state recordings were obtained from 180 DPN patients.

Towards a framework for comparing functionalities of multimorbidity clinical decision support: A literature-based feature set and benchmark cases.

Multimorbidity, the coexistence of two or more health conditions, has become more prevalent as mortality rates in many countries have declined and their populations have aged. Multimorbidity presents significant difficulties for Clinical Decision Support Systems (CDSS), particularly in cases where recommendations from relevant clinical guidelines offer conflicting advice. A number of research groups are developing computer-interpretable guideline (CIG) modeling formalisms that integrate recommendations from multiple Clinical Practice Guidelines (CPGs) for knowledge-based multimorbidity decision support.

Bi-allelic variants in the mitochondrial RNase P subunit PRORP cause mitochondrial tRNA processing defects and pleiotropic multisystem presentations.

Human mitochondrial RNase P (mt-RNase P) is responsible for 5' end processing of mitochondrial precursor tRNAs, a vital step in mitochondrial RNA maturation, and is comprised of three protein subunits: TRMT10C, SDR5C1 (HSD10), and PRORP. Pathogenic variants in TRMT10C and SDR5C1 are associated with distinct recessive or x-linked infantile onset disorders, resulting from defects in mitochondrial RNA processing. We report four unrelated families with multisystem disease associated with bi-allelic variants in PRORP, the metallonuclease subunit of mt-RNase P.

Outcomes of pituitary apoplexy: a comparison of microadenomas and macroadenomas.

Purpose: We aimed to assess clinical characteristics of apoplexy of pituitary microadenomas compared to macroadenomas.

Methods: We retrieved clinical records of patients > 18 years old, hospitalized in Rambam hospital between January 2001 and October 2017, with pituitary apoplexy and follow-up of at least one year. We compared clinical course and outcomes of apoplexy between patients with microadenomas and macroadenomas, and between patients who received conservative or surgical treatment.

Towards a goal-oriented methodology for clinical-guideline-based management recommendations for patients with multimorbidity: GoCom and its preliminary evaluation.

Patients with chronic multimorbidity are becoming more common as life expectancy increases, making it necessary for physicians to develop complex management plans. We are looking at the patient management process as a goal-attainment problem. Hence, our aim is to develop a goal-oriented methodology for providing decision support for managing patients with multimorbidity continuously, as the patient's health state is progressing and new goals arise (e.

Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries.

Background: Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person's life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users.

Assessment of the Frequency of Online Searches for Symptoms Before Diagnosis: Analysis of Archival Data.

Background: Surveys suggest that a large proportion of people use the internet to search for information on medical symptoms they experience and that around one-third of the people in the United States self-diagnose using online information. However, surveys are known to be biased, and the true rates at which people search for information on their medical symptoms before receiving a formal medical diagnosis are unknown.

Objective: This study aimed to estimate the rate at which people search for information on their medical symptoms before receiving a formal medical diagnosis by a health professional.

Analyzing Medical Research Results Based on Synthetic Data and Their Relation to Real Data Results: Systematic Comparison From Five Observational Studies.

Background: Privacy restrictions limit access to protected patient-derived health information for research purposes. Consequently, data anonymization is required to allow researchers data access for initial analysis before granting institutional review board approval. A system installed and activated at our institution enables synthetic data generation that mimics data from real electronic medical records, wherein only fictitious patients are listed.

Antihyperglycemic therapy during colonoscopy preparation: A review and suggestions for practical recommendations.

Patients with diabetes have distinct risks during precolonoscopy bowel preparation, caused by change of diet, change of antihyperglycemic medication regimens and diabetes-related complications and comorbidities. These risks include hypoglycemia, water and electrolyte imbalance, acute renal failure, lactic acidosis, ketoacidosis and low quality of bowel preparation. Here we review the existing literature and present recommendations from a subcommittee of the Israeli National Diabetes Council for primary care physicians and gastroenterologists.

Evolutionary Perspective in Rickets and Vitamin D.

Modern lifestyle limits our exposure to sunlight, which photosynthesizes vitamin D in the skin, and the incidence of nutritional rickets has been resurging. Vitamin D is one of the first hormones; it is photosynthesized in all organism from the phytoplankton to mammals. A selective sweep of the promoter of the vitamin D receptor (VDR) happened as soon as migrated out of Africa; it co-adapted with skin color genes to provide adaptation to latitudes and the levels of exposure to ultraviolet (UV)B radiation along the route out of Africa.

Can internet search engine queries be used to diagnose diabetes? Analysis of archival search data.

Aims: Diabetes is often diagnosed late. This study aimed to assess the possibility for earlier detection of diabetes from search data, using predictive models trained on large-scale data.

Methods: We extracted all English-language queries made by people in the USA to Bing during 1 year and identified queries containing symptoms of diabetes.

Managing Diabetes in Patients Hospitalized in Internal Medicine Units.

Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient's weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients.

Glucocorticoid-Induced Metabolic Disturbances Are Exacerbated in Obese Male Mice.

The purpose of this study was to determine the effects of glucocorticoid-induced metabolic dysfunction in the presence of diet-induced obesity. C57BL/6J adult male lean and diet-induced obese mice were given dexamethasone, and levels of hepatic steatosis, insulin resistance, and lipolysis were determined. Obese mice given dexamethasone had significant, synergistic effects on fasting glucose, insulin resistance, and markers of lipolysis, as well as hepatic steatosis.

Management of cystic prolactinomas: a review.

Introduction: Cystic prolactinoma is a variant of prolactin-secreting pituitary adenoma. The strategies for the management of cystic prolactinoma have not been addressed thoroughly in clinical guidelines.

Methods: A literature search was performed using Pubmed to review the current approaches to the treatment of cystic prolactinoma.

A Young Patient with Leg Weakness and Hypokalemia-Case Report.

A 20-year-old female patient was admitted to hospital because of bilateral leg weakness. Laboratory investigation showed metabolic alkalosis and severe hypokalemia. Differential diagnosis included mineralocorticoid or apparent mineralocorticoid excess diseases, with a high aldosterone-to-renin ratio (ARR) after correcting hypokalemia.

Encouraging Physical Activity in Patients With Diabetes: Intervention Using a Reinforcement Learning System.

Background: Regular physical activity is known to be beneficial for people with type 2 diabetes. Nevertheless, most of the people who have diabetes lead a sedentary lifestyle. Smartphones create new possibilities for helping people to adhere to their physical activity goals through continuous monitoring and communication, coupled with personalized feedback.

Interaction Between the Haptoglobin Genotype and Vitamin E on Cardiovascular Disease in Diabetes.

Purpose Of Review: Despite compelling evidence regarding the importance of oxidant stress in the development of vascular complications and observational studies suggesting that vitamin E may be protective from these complications, multiple clinical trials have failed to show benefit from vitamin E supplementation in the prevention of vascular complications in diabetes. One possible explanation for this failure of vitamin E may have been inappropriate patient selection. This review seeks to provide the clinical evidence and mechanistic basis for why a subset of individuals defined by their haptoglobin (Hp) genotype may derive cardiovascular protection by vitamin E supplementation.

Gene expression changes in subcutaneous adipose tissue due to Cushing's disease.

Glucocorticoids have major effects on adipose tissue metabolism. To study tissue mRNA expression changes induced by chronic elevated endogenous glucocorticoids, we performed RNA sequencing on the subcutaneous adipose tissue from patients with Cushing's disease (n=5) compared to patients with nonfunctioning pituitary adenomas (n=11). We found a higher expression of transcripts involved in several metabolic pathways, including lipogenesis, proteolysis and glucose oxidation as well as a decreased expression of transcripts involved in inflammation and protein synthesis.

Gene Expression Signature in Adipose Tissue of Acromegaly Patients.

To study the effect of chronic excess growth hormone on adipose tissue, we performed RNA sequencing in adipose tissue biopsies from patients with acromegaly (n = 7) or non-functioning pituitary adenomas (n = 11). The patients underwent clinical and metabolic profiling including assessment of HOMA-IR. Explants of adipose tissue were assayed ex vivo for lipolysis and ceramide levels.