OHDSI MEETINGS THIS WEEK
The Book of OHDSI working group meeting - Tuesday at 11am ET
Zoom URL: https://columbiauniversity.zoom.us/j/258043190
OHDSI Community Call - Tuesday at 12pm ET
OMOP CDM Oncology WG - Development Subgroup Meeting - Wednesday at 10 ET
ATLAS workgroup meeting - Wednesday at 10am ET
Natural Language Processing WG - Wednesday at 2pm ET
Patient-Level Prediction meeting - Wednesday at 2pm ET
Population-Level Estimation WG (Eastern Hemisphere) - Thursday at 4pm KST
OMOP CDM Oncology WG - CDM/Vocabulary Subgroup Meeting - Thursday at 10am ET
OMOP CDM Oncology WG - Genomic Subgroup Meeting - Friday at 10am ET
EHR Work Group Meeting - Friday at 10am ET
You can find a full list of upcoming OHDSI meetings here:
Two OHDSI studies published in Lancet! Another OHDSI study has been published in Lancet! The EHDEN team’s Rheumatology paper is available here: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(19)30075-X/fulltext
If you haven’t yet checked out the LEGEND hypertension study in the Lancet, you can check it out here:
For more info on the study, check out our press release:
OHDSI Symposium Page - A full recap of the 2019 OHDSI U.S. Symposium, including photos, videos, collaborator showcase posters, and more, is available here https://www.ohdsi.org/2019-us-symposium-page/ . You can find it on the front page under the Symposium recap video, or as the first dropdown under the “2019 OHDSI Symposium” menu. Presentation slides are available there, and Symposium talks will begin to be posted this week, starting with the morning plenary session.
OHDSI Social Showcase We are posting one poster/demo/lightning talk from the Collaborator Showcase ( #OHDSISocialShowcase) each weekday on both our Twitter and LinkedIn pages. Please check these out if you are on either, and share to promote all the great work OHDSI is doing. If you took part in the Collaborator Showcase, you’ll get an email on the Monday of the week you will be included to help you promote it.
2019 OHDSI Symposium - Videos Videos from the 2019 OHDSI symposium are being uploaded here: https://www.youtube.com/playlist?list=PLpzbqK7kvfeVWtDEc4VGmI1F_EBi_sJOF
A separate playlists for tutorials are also being uploaded this week.
It’s all right letting yourself go, as long as you can get yourself back.
Mick Jagger COMMUNITY PUBLICATIONS
Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance.
K Berencsi, A Sami, MS Ali, K Marinier, N Deltour, S Perez-Guthann, L Pedersen, P Rijnbeek, J Van der Lei, F Lapi, M Simonetti, C Reyes, MCJM Sturkenboom and D Prieto-Alhambra,
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Nov 2019 06
In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK).the database source populations were included for population-based analyses, and SR users for patient-level analyses.New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy.Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016).The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period.Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
A Framework for Improving Characterization of Obstetric Hemorrhage Using Informatics Data.
D Goffman, AM Friedman, JJ Sheen, A Kessler, D Vawdrey, R Green, ME D'Alton and M Oberhardt,
Obstetrics and gynecology, Nov 2019 04
To characterize postpartum hemorrhage trends and outcomes using bioinformatics and electronic health record data.This retrospective analysis included all women who delivered in a four-hospital system from July 2014 to July 2017 during implementation of a postpartum hemorrhage bundle. Data on billing codes, uterotonics, transfusion, intrauterine tamponade device placement, and hysterectomy were analyzed. A framework of four postpartum hemorrhage levels based on hemorrhage interventions was created using this informatics data. Levels were analyzed in relation to hematocrit drop from the highest predelivery to the lowest postpartum level. Changes in treatment patterns were assessed with risk-adjusted regression models with adjusted odds ratios (aOR) and 95% CI as the measures of effect. Postpartum hemorrhage-associated severe maternal morbidities were analyzed with adjusted models.The cohort included 43,657 deliveries. Four mutually exclusive postpartum hemorrhage levels were created based on informatics and billing criteria. Level 1: receipt of uterotonic other than oxytocin (3.7% of patients); level 2: billing diagnosis code for postpartum hemorrhage (3.0% of patients); level 3: placement of the intrauterine tamponade device, transfusion of 1-3 units red blood cells (RBCs), or both (1.8% of patients); and Level 4: hysterectomy, 4 or more units RBCs, or both (0.6% of patients). Higher postpartum hemorrhage levels were associated with higher hematocrit drops. In postpartum hemorrhage levels 1 through 4, 1.6%, 5.6%, 30.2%, and 30.7% of women had hematocrit drops greater than 40%, compared with 0.4% of women without postpartum hemorrhage. Over the course of the study, hematocrit drops within a given level did not change. Postpartum hemorrhage interventions such as uterotonics increased significantly (aOR 1.16, 95% CI 1.11-1.21, with aOR denoting change in outcome across 1 year). Although severe maternal morbidity did not change significantly, risk of hysterectomy decreased significantly (aOR 0.52, 95% CI 0.40-0.68).Postpartum hemorrhage can be characterized in a granular fashion with informatics data. Informatics data are becoming increasingly available and can provide detailed assessment of postpartum hemorrhage incidence, management, and outcomes to facilitate surveillance and quality improvement.
Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center.
BR Kummer, JZ Willey, MJ Zelenetz, Y Hu, S Sengupta, MSV Elkind and G Hripcsak,
Applied clinical informatics, Oct 2019
Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.
(ADRB2) Gene Polymorphisms and Risk of COPD Exacerbations: The Rotterdam Study.
L Karimi, L Lahousse, M Ghanbari, N Terzikhan, AG Uitterlinden, J van der Lei, GG Brusselle, BH Stricker and KMC Verhamme,
Journal of clinical medicine, Nov 2019 01
The role of the β2-adrenergic receptor (ADRB2) gene in patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated the association between ADRB2 variants and the risk of exacerbations in COPD patients treated with inhaled β2-agonists. Within the Rotterdam Study, a population-based cohort study, we followed 1,053 COPD patients until the first COPD exacerbation or end of follow-up and extracted rs1042713 (16Arg > Gly) and rs1042714 (27Gln > Glu) in ADRB2. Exposure to inhaled β2-agonists was categorised into current, past or non-use on the index date (date of COPD exacerbation for cases and on the same day of follow-up for controls). COPD exacerbations were defined as acute episodes of worsening symptoms requiring systemic corticosteroids and/or antibiotics (moderate exacerbations), or hospitalization (severe exacerbations). The associations between ADRB2 variants and COPD exacerbations were assessed using Cox proportional hazards models, adjusting for age, sex, use of inhaled corticosteroids, daily dose of β2-agonists, and smoking. In current users of β2-agonists, the risk of COPD exacerbation decreased by 30% (hazard ratio (HR); 0.70, 95% CI: 0.59-0.84) for each copy of the Arg allele of rs1042713 and by 20% (HR; 0.80, 95% CI: 0.69-0.94) for each copy of the Gln allele of rs1042714. Furthermore, current users carrying the Arg16/Gln27 haplotype had a significantly lower risk (HR; 0.70, 95% CI: 0.59-0.85) of COPD exacerbation compared to the Gly16/Glu27 haplotype. In conclusion, we observed that the Arg16/Gln27 haplotype in ADRB2 was associated with a reduced risk of COPD exacerbation in current users of inhaled β2-agonists.
Key Considerations for Incorporating Conversational AI in Psychotherapy.
AS Miner, N Shah, KD Bullock, BA Arnow, J Bailenson and J Hancock,
Frontiers in psychiatry, 2019
Conversational artificial intelligence (AI) is changing the way mental health care is delivered. By gathering diagnostic information, facilitating treatment, and reviewing clinician behavior, conversational AI is poised to impact traditional approaches to delivering psychotherapy. While this transition is not disconnected from existing professional services, specific formulations of clinician-AI collaboration and migration paths between forms remain vague. In this viewpoint, we introduce four approaches to AI-human integration in mental health service delivery. To inform future research and policy, these four approaches are addressed through four dimensions of impact: access to care, quality, clinician-patient relationship, and patient self-disclosure and sharing. Although many research questions are yet to be investigated, we view safety, trust, and oversight as crucial first steps. If conversational AI isn't safe it should not be used, and if it isn't trusted, it won't be. In order to assess safety, trust, interfaces, procedures, and system level workflows, oversight and collaboration is needed between AI systems, patients, clinicians, and administrators.