A vision of the journey ahead: using public health notifiable condition mapping to illustrate the need to maintain value sets.

Maintaining value sets is a necessary and distinct activity apart from maintaining recognized controlled vocabularies. As an illustration of one such value set, we evaluate the CDC and Regenstrief versions of the notifiable condition mapping tables (NCMT) and illustrate they are not synchronized. We used practical informatics approaches including heuristic queries and similarity measures to accurately identify more than 800 new candidate reportable LOINC codes.

Midterm results of Ross aortic valve replacement: a single-institution experience.

Background: We reviewed our institutional midterm experience to assess autograft and homograft hemodynamics and reoperative frequency after Ross aortic valve replacement.

Methods: Between June 1993 and January 2009, 212 consecutive patients (mean age, 24.8 +/- 15.

Three-dimensional stress echocardiography: the promise and limitations of volumetric imaging.

Purpose Of Review: Three-dimensional (3D) volumetric imaging has potential advantages in stress echocardiography, including the ability to provide an unlimited number of planes for analysis and more rapid acquisition than conventional two-dimensional (2D) imaging. This review focuses on the advantages and disadvantages of 3D volumetric imaging and the current and future role of the technique in stress echocardiography.

Recent Findings: Three-dimensional volumetric imaging uniformly shortens the time required for acquisition of stress images.

Salvage procedures for the distal end of the ulna: there is no magic.

Resection of the distal end of the ulna is not a benign procedure; nor is it a panacean surgical treatment of disorders at the distal radioulnar and ulnocarpal joints. Over the past 96 years, since Darrach first described his classic procedure, many authors have warned surgeons of the consequences of the Darrach resection. For salvaging the persistently painful distal forearm after Darrach resection, researchers have recommended a spectrum of possible surgical options.

Understanding and treating moyamoya disease in children.

Moyamoya disease, a known cause of pediatric stroke, is an unremitting cerebrovascular occlusive disorder of unknown etiology that can lead to devastating, permanent neurological disability if left untreated. It is characterized by progressive stenosis of the intracranial internal carotid arteries and their distal branches and the nearly simultaneous appearance of basal arterial collateral vessels that vascularize hypoperfused brain distal to the occluded vessels. Moyamoya disease may be idiopathic or may occur in association with other syndromes.

Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis.

A number of afflictions may affect the distal radioulnar joint that can lead to severe pain, disuse, dysfunction, and disability. The disorders that affect this small anatomic region are complex, have multifactorial etiologies, and can sometimes present difficult diagnostic and treatment options. This article presents an overview of recent developments in the diagnosis and treatment of a variety of conditions that affect the joint and surrounding bone and soft tissues.

Implementing broad scale childhood immunization decision support as a web service.

Timely vaccinations decrease a child's risk of contracting vaccine-preventable disease and prevent disease outbreaks. Childhood immunization schedules may represent the only clinical guideline for which there is official national consensus. So an immunization clinical decision support system (CDSS) is a natural application.

A comparison of automated methicillin-resistant Staphylococcus aureus identification with current infection control practice.

Infections with Methicillin-Resistant Staphylococcus aureus (MRSA) account for almost 20,000 deaths per year. Early identification of patients with MRSA infection or colonization aids in stopping spread. We compared automated identification of MRSA using HL7 lab result messages to current manual infection control practices at a local hospital during July-September 2008.

Right ventricular outflow tract reconstruction in Ross patients: does the homograft fare better?

Background: In the Ross aortic valve replacement (AVR) procedure, the right ventricular outflow tract (RVOT) conduit is inserted in an orthotopic position. In complex congenital RVOT obstruction, the right ventricular-pulmonary artery (RV-PA) conduit is placed in a more heterotopic position. We hypothesized that durability of homograft RVOT reconstruction in the Ross AVR is improved secondary to orthotopic positioning and the ability to oversize the RV-PA homograft conduit in the Ross AVR.

Cervical kinematics after fusion and bryan disc arthroplasty.

Introduction: Disc arthroplasty has been shown to provide short-term clinical results that are comparable with those attained with traditional anterior cervical discectomy and fusion. One proposed benefit of arthroplasty is the ability to prevent or delay adjacent level operations by retaining motion at the target level and eliminating abnormal adjacent activity. This paper compares motion parameters for single-level anterior cervical discectomy and fusion and disc replacement patients at the index level and adjacent segments.

In vivo selection of hematopoietic stem cells transduced at a low multiplicity-of-infection with a foamy viral MGMT(P140K) vector.

Objective: Using a clinically relevant transduction strategy, we investigated to what extent hematopoietic stem cells in lineage-negative bone marrow (Lin(neg) BM) could be genetically modified with an foamy virus (FV) vector that expresses the DNA repair protein, O(6)-methylguanine DNA methyltransferase (MGMT(P140K)) and selected in vivo with submyeloablative or myeloablative alkylator therapy.

Materials And Methods: Lin(neg) BM was transduced at a low multiplicity-of-infection with the FV vector, MD9-P140K, which coexpresses MGMT(P140K) and the enhanced green fluorescent protein, transplanted into C57BL/6 mice, and mice treated with submyeloablative or myeloablative alkylator therapy. The BM was analyzed for the presence of in vivo selected, MD9-P140K-transduced cells at 6 months post-transplantation and subsequently transplanted into secondary recipient animals.

Hate crimes and the forensic pathologist.

Hate crimes represent crimes committed against an individual or group on the basis of their race, ethnicity, national origin, religion, sexual orientation, gender, gender identity, or disability. For the forensic pathologist, a death related to a hate crime should be considered a high-profile case, one in which the pathologist should expect abundant public interest and scrutiny. In this article, an overview of hate crimes is presented, stressing the different types of hate crimes and the motives of those who commit such crimes.

Modified ureterosigmoidostomy (Mainz Pouch II): a nonrefluxing stented vs unstented laparoscopic porcine model.

Objective: To describe a rapid and reproducible pure laparoscopic cystectomy and nonrefluxing modified continent urinary diversion (Mainz Pouch II), and to determine whether ureteric stenting decreases ureteric obstruction after surgery.

Materials And Methods: After institutional review and approval, six female pigs (51-55 kg) had a laparoscopic cystectomy and urinary diversion using a modified Mainz Pouch II. Imbricating bowel over the extra-intestinal ureteric segment created the nonrefluxing mechanism.

Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience.

Objective: Transannular patching of the right ventricular outflow tract results in pulmonary insufficiency. Biologic monocusp valves prevent early pulmonary insufficiency but usually become nonfunctional in less than 1 year. Polytetrafluoroethylene monocusp leaflets demonstrated favorable characteristics in our animal studies and have been applied to a variety of right ventricular outflow tract reconstructions at our institution.

Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up.

Background: Although recent studies have shown intermediate-term success of both meniscal allograft transplantation (MAT) and autologous chondrocyte implantation (ACI) performed separately, there have been no peer-reviewed studies focused prospectively on the combined procedure. By potentially reestablishing a compartment contact area closer to normal, MAT may allow a more optimal environment for ACI by reducing stress (stress =force/unit area). On the other hand, the literature suggests that MAT alone in the presence of extensive chondrosis performs poorly.

Metacognition within narratives of schizophrenia: associations with multiple domains of neurocognition.

Research has suggested many with schizophrenia experience impairments in metacognition, or difficulties apprehending their own thoughts and the thoughts of others, and that those deficits are not reducible to a single symptom or cognitive impairment. While links between metacognition and more severe levels of symptoms have emerged, less clear is whether there are consistent associations between metacognition and other neurocognitive capacities. Accordingly the current study sought to examine whether different patterns of metacognition deficits have different neurocognitive correlates.

Surgical results of arterial switch operation for Taussig-Bing anomaly: is position of the great arteries a risk factor?

Background: A variety of definitive operations have been used to manage patients with double-outlet right ventricle and subpulmonary ventricular septal defect (Taussig-Bing anomaly). This study identifies the impact of the position of the great arteries and use of a staged surgical approach on the outcome after the arterial switch operation in children with Taussig-Bing anomaly.

Methods: From 1986 through July 2005, 34 patients with Taussig-Bing anomaly underwent the arterial switch operation.

A natural language processing system to extract and code concepts relating to congestive heart failure from chest radiology reports.

We have developed a natural language processing system for extracting and coding clinical data from free text reports. The system is designed to be easily modified and adapted to a variety of free text clinical reports such as admission notes, radiology and pathology reports, and discharge summaries. This report presents the results of this system to extract and code clinical concepts related to congestive heart failure from 39,000 chest radiology reports.

Neurofibromin plays a critical role in modulating osteoblast differentiation of mesenchymal stem/progenitor cells.

Mutations in the NF1 tumor suppressor gene cause neurofibromatosis type 1, a pandemic autosomal dominant genetic disorder with an incidence of 1:3000. Individuals with NF1 have a variety of malignant and non-malignant manifestations, including skeletal manifestations, such as osteoporosis, scoliosis and short statures. However, the mechanism(s) underlying the osseous manifestations in NF1 are poorly understood.

A call for collaboration: building an EMR for developing countries.

Millions of people are either living with or dying from HIV/AIDS; most of this living and dying is taking place in developing countries. There is an immediate need for electronic medical record systems to help scale up HIV/AIDS prevention and treatment programs, reduce critical human errors, and support the research necessary to guide future efforts. Several groups are working on this problem, but most of this work is occurring within silos.

Automated mapping of local radiology terms to LOINC.

We developed an automated tool, called the Intelligent Mapper (IM), to improve the efficiency and consistency of mapping local terms to LOINC. We evaluated IM's performance in mapping diagnostic radiology report terms from two hospitals to LOINC by comparing IM's term rankings to a manually established gold standard. Using a CPT-based restriction, for terms with a LOINC code match, IM ranked the correct LOINC code first in 90% of our development set terms, and in 87% of our test set terms.