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- ArticleSchön V, Farbmacher A, Grassner L, Klein B, Thomé C, Pinggera D.Brain Spine. 2025;5:104159.Introduction: In February 2020, COVID-19 infections started to spread in Austria. This was followed by governmental actions and constraints such as lockdowns, quarantine protocols, and a ban on outdoor sports. The goal of this study was to investigate the influence of these measures on the number of traumatic brain injuries (TBI) in the state of Tyrol.
Methods: The incidence of TBI during lockdowns and restrictions of outdoor activities in 2020 and 2021 were compared with corresponding periods in previous years. The data was retrospectively collected and analyzed.
Results: During the first lockdown in the winter of 2020/2021, there was a notably lower incidence of moderate and severe TBIs compared to the corresponding period in 2019/2020 (p = 0.016). Similarly, there was a reduction in TBIs from sports accidents during this period (p = 0.010). However, when comparing other lockdown periods to the previous years, no differences were observed.
Conclusion: The various governmental measures restricting mobility aimed to contain the COVID-19 pandemic but showed little influence on the number of TBI cases. Only a lockdown in the accident-prone winter months has influenced the incidence of TBIs. - ArticleSmith ME, Newberry KM, Bailey HR.Cognition. 2020 03;196:104159.We deconstruct continuous streams of action into smaller, meaningful events. Research has shown that the ability to segment continuous activity into such events and remember their contents declines with age; however, knowledge improves with age. We investigated how young and older adults use knowledge to more efficiently encode and later remember information from everyday events by having participants view a series of self-paced slideshows depicting everyday activities. For some activities, older adults produce more normative scripts than do young adults (older adult activities) and for other activities, young adults produce more normative scripts than do older adults (young adult activities). Overall, participants viewed event boundaries longer than within events (i.e., the event boundary advantage) replicating prior research (e.g., Hard, Recchia, & Tversky, 2011). Importantly, older adults demonstrated the boundary advantage for the older adult activities but not the young adult activities, and they also had better recognition memory for the older adult activities than the young adult activities. We also found that the magnitude of a participant's boundary advantage was associated with better memory, but only for the less knowledgeable activities. Results indicate that older adults use their intact knowledge to better encode and remember everyday activities, but that knowledge and event segmentation may have independent influences on event memory.
- ArticlePopa N, Bachar D, Roberts AC, Santangelo AM, Gascon E.EBioMedicine. 2022 Aug;82:104159.BACKGROUND: Psychiatric diseases such as depression and anxiety are multifactorial conditions, highly prevalent in western societies. Human studies have identified a number of high-risk genetic variants for these diseases. Among them, polymorphisms in the promoter region of the serotonin transporter gene (SLC6A4) have attracted much attention. However, due to the paucity of experimental models, molecular alterations induced by these genetic variants and how they correlate to behavioral deficits have not been examined. In this regard, marmosets have emerged as a powerful model in translational neuroscience to investigate molecular underpinnings of complex behaviors.
METHODS: Here, we took advantage of naturally occurring genetic polymorphisms in marmoset SLC6A4 gene that have been linked to anxiety-like behaviors. Using FACS-sorting, we profiled microRNA contents in different brain regions of genotyped and behaviorally-phenotyped marmosets.
FINDINGS: We revealed that marmosets bearing different SLC6A4 variants exhibit distinct microRNAs signatures in a region of the prefrontal cortex whose activity has been consistently altered in patients with depression/anxiety. We also identified Deleted in Colorectal Cancer (DCC), a gene previously linked to these diseases, as a downstream target of the differently expressed microRNAs. Significantly, we showed that levels of both microRNAs and DCC in this region were highly correlated to anxiety-like behaviors.
INTERPRETATION: Our findings establish links between genetic variants, molecular modifications in specific cortical regions and complex behavioral responses, providing new insights into gene-behavior relationships underlying human psychopathology.
FUNDING: This work was supported by France National Agency, NRJ Foundation, Celphedia and Fondation de France as well as the Wellcome Trust. - ArticleHan F, Jin X, Yuan X, Bai Z, Wang Q, Xie H.J Dent. 2022 07;122:104159.OBJECTIVES: To evaluate the interactions of two phosphate ester monomers [10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and dipentaerythritol penta-acrylate phosphate (PENTA)] with hydroxyapatite and collagen and understand their influence on dentine bonding.
METHODS: Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, nuclear magnetic resonance, ultraviolet-visible, and molecular docking were applied for separately evaluating the interactions of two monomers with hydroxyapatite and collagen. Hydrophilicity tests and morphological observation were employed to characterize pretreated dentine. Microtensile bond strength (μTBS) and nanoleakage were investigated to evaluate the bonding performance. Hydroxyproline assay, in situ zymography, and matrix metalloproteinase-9 (MMP-9) activity assay were used to confirm the MMP inhibition.
RESULTS: Chemoanalytic characterization confirmed the interactions of 10-MDP and PENTA with hydroxyapatite and collagen. The interactions of PENTA were weaker than 10-MDP. PENTA possessed better dentine tubule sealing after etching than 10-MDP. Dentine treated with PENTA was more hydrophilic than 10-MDP. 10-MDP and PENTA treating significantly increased the initial μTBS than the control group without primer conditioning. μTBS decreased significantly during aging, and the decrease was more severe in the PENTA group than 10-MDP. The 10-MDP and PENTA groups exhibited relatively less fluorescence than the control. The relative inhibition percentages of MMP-9 decreased in the order of 10-MDP-Ca salt, 10-MDP and PENTA. The 10-MDP, PENTA, and 10-MDP-Ca salt groups showed significantly lower hydroxyproline contents than the control.
CONCLUSIONS: Although PENTA adsorbed on hydroxyapatite, it did not form a stable calcium salt. The interactions of 10-MDP with hydroxyapatite and collagen are different than those of PENTA.
CLINICAL SIGNIFICANCE: The sealing of dentinal tubules by PENTA and the inhibition of MMP by 10-MDP and its calcium salts contribute to improving the dentine bonding durability. - ArticleRahman MA, Kanda Y, Ozawa M, Kawamura T, Takeuchi A, Katakai T.Cell Immunol. 2020 09;355:104159.Immune responses to non-pathogenic yeasts induced within the draining lymph node remain to be understood. In this study, we have investigated the changes in lymphocytes and their activity in skin-draining lymph nodes in response to transdermally injected zymosan (component of the yeast cell wall). Zymosan elicited the transient increase of B cell number and activation status without affecting the capacity for proliferation. The increased B cell content in the regional lymph nodes was likely due to the reduction of B cell egress from the tissue and in part the increase of homing from the circulation. Zymosan also upregulated the inflammatory cytokines, such as IL-1β, IL-6, IL-12, and IFNγ, regulatory cytokines IL-10 and TGFβ, and lymphoid chemokine CXCL13. Among these, the expression of IL-12 and IL-10 was markedly high in B cells. Altogether, these findings demonstrate a unique B cell-associated response to non-pathogenic yeast component in the draining lymph nodes. This will provide insights into the clinical and healthcare applications of non-pathogenic beneficial microbes.
- ArticleAl-Khresheh MH.Acta Psychol (Amst). 2024 Mar;243:104159.In the world of English as a Foreign Language pedagogy, the efficacy of interactive instructional methods, particularly presentation-based activities, has garnered increasing attention. This study aimed to elucidate the potency of such activities in boosting the speaking prowess of Saudi English students. Employing a purposive sampling technique, 16 male students were methodically selected and partitioned into experimental and control groups. Through a quasi-experimental design, the study assessed linguistic proficiency using a detailed pre- and post-intervention rubric. Empirical findings revealed a significant enhancement in the experimental group's speaking skills after immersion in presentation-driven tasks. This was evident in improved fluency and coherence, enriched lexical resources, heightened grammatical range and accuracy, superior pronunciation, more compelling content delivery, and enhanced engagement and interaction skills. Crucially, this observed improvement in speaking skills among participants may be attributed to enhanced self-confidence fostered through their engagement in presentation-based activities, an integral facet of efficacious language learning. This research underscores the importance of integrating practical tasks in EFL curricula and aligns with previous academic discourses that emphasise the virtues of hands-on learning. These insights hold significant implications for educators, curriculum designers, and education policymakers in refining EFL instructional practices and fostering genuine language mastery.
- ArticleMa J, Wang Y, Joshi S, Wang H, Young C, Pervez A, Qu Y, Washburn S.Appl Ergon. 2024 Feb;115:104159.The U.S. faces a national shortage of nurses. The emergence of human-centered digital technologies has directly impacted nursing education. Using immersive Virtual Reality related digital technology to assist and enhance nurse education is promising but not yet fully understood. This study aims to understand the effectiveness and efficacy of immersive Virtual Reality nursing education approaches through a comparative pilot study. Three immersive Virtual Reality scenarios based on basic nursing skills were developed. A traditional video lecture approach including the same contents was used as a comparable approach to investigate the effectiveness and efficacy performance of the proposed immersive Virtual Reality approach. 22 participants were recruited from a college. Effectiveness was measured through motivation and knowledge gain, while efficacy was evaluated through simulation sickness, user experience, and system usability. The results showed that the VR approach has above "acceptable" efficacy performance, which indicates participants are willing to accept this novel education approach. The effectiveness results indicate that the VR approach has similar performance with the video approach in delivering nursing contents. One limitation of this investigation is that the sample size is relatively small and further larger sample sizes are needed for future analysis.
- ArticleAljasir SF, D'Amico DJ.Food Microbiol. 2023 Apr;110:104159.Salmonella enterica is a ubiquitous and multi-host pathogen that causes significant morbidity and mortality worldwide. Outbreaks of foodborne salmonellosis continue to occur, highlighting the need for additional interventions. The present study investigated the potential for the commercial protective culture Hafnia alvei B16 to provide enhanced protection against multi-drug resistant strains of S. enterica serovars Typhimurium and Newport by attenuating their virulence when cocultured in milk (as a model food) and broth, and by protecting intestinal epithelial cells from pathogen infection in vitro. Exposure to HA in milk inhibited the subsequent adhesion of S. Typhimurium by 95.23%, whereas the invasion capacity of both serovars was reduced when cocultured with HA in broth and milk. The inhibition of invasion by S. Typhimurium and S. Newport was greater when cocultured in milk (86.95% and 86.58%, respectively) compared to broth (51.64% and 79.88%, respectively). Exposure to HA in both media decreased the expression of virulence genes in S. Typhimurium and S. Newport. Pre-treatment of Caco-2 cells with HA reduced invasion of S. Newport by 89.68% compared to control. These data demonstrate the potential for HA to enhance food safety by attenuating Salmonella virulence and protecting against pathogen invasion of intestinal epithelial cells.
- ArticleTonkin SS, Hawk LW.Behav Processes. 2020 Sep;178:104159.Research suggests that repetitive reinforcers wane in their ability to maintain operant behavior in a manner consistent with habituation. Weaker reinforcers, including sensory stimuli common in human work, may be most impacted by repetition. The present research examined within-session operant responding patterns for visual stimuli in humans from two experiments assessing multiple characteristics of habituation. In Experiment 1, declines in reinforced responding were assessed and stimulus specificity was evaluated to test habituation's contribution to these declines. Seventy-three participants completed two visits, both including a reinforcement paradigm using pictures. With repetition, operant responding declined. The stimulus specificity manipulation did not enhance responding, suggesting that habituation did not contribute to response declines. Several methodological concerns may have contributed to the absence of a stimulus specificity effect. Experiment 2 assessed a separate habituation characteristic, rate of stimulation, to address these methodological concerns and further evaluate habituation. Twenty-eight participants completed the reinforcement paradigm over three visits. Decline in responding was partially supported, but the rate of stimulation did not alter declines. In sum, habituation's contribution to within-session declines for sensory reinforcers was not evident in either experiment. These results suggest that assessment of habituation of sensory reinforcers in humans may require parametric evaluation.
- ArticleUnal E, Ozdemir A, Aydın MO, Alper Z.Nurse Educ Pract. 2024 Nov;81:104159.AIM: To examine the effect of standardised patient simulation training on nursing students' skills and knowledge in administering the Bacillus Calmette-Guérin vaccine, as well as their satisfaction and self-confidence.
BACKGROUND: The Bacillus Calmette-Guérin vaccine is administered by nurses to prevent tuberculosis. However, there have been reports of complications arising from inadequate knowledge and skills related to Bacillus Calmette-Guérin vaccine administration.
DESIGN: A randomised controlled experimental design.
METHOD: This experimental study was conducted between October 2022 and January 2023 at a university, Medical Training and Simulation Centre. The fourth-year nursing students enrolled in their intern term were asked to participate in this experimental study. Participants were allocated to the intervention group (n=45) and the control group (n=45). The control group received only theoretical training and then BCG application on the model. The socio-demographic survey was conducted to collect demographic data. The Bacillus Calmette-Guérin Vaccine Knowledge Form, Bacillus Calmette-Guérin Vaccine Administration Checklist, and the student satisfaction and self-confidence scale in learning were used. The intervention group received simulation training using a standardized patient. All students' knowledge and skills were measured before and 3 months after the theoretical training.
RESULTS: Simulation training using standardized patients significantly increased nursing students' Bacillus Calmette-Guérin vaccine knowledge (intervention group=21.57±5.12; control group=15.33±5.61), skills (intervention group=20.88±4.29; control group=10.22±4.56), confidence and satisfaction (intervention group=4.61±0.30; control group=4.17±0.3) compared with the control group (p < 0.05).
CONCLUSION: Training with standardized patient techniques provides students the opportunity to practice realistically in a safe environment, enabling repetitive practice, which enhances self-confidence and satisfaction. - ArticleSaviour CM, Gupta S.Med Eng Phys. 2024 04;126:104159.Generation of polyethylene wear debris and peri‑prosthetic bone resorption have been identified as potential causes of acetabular component loosening in Total Hip Arthroplasty. This study was aimed at optimization of a functionally graded porous acetabular component to minimize peri‑prosthetic bone resorption and polyethylene liner wear. Porosity levels (porosity values at acetabular rim, and dome) and functional gradation exponents (radial and polar) were considered as the design parameters. The relationship between porosity and elastic properties were obtained from numerical homogenization. The multi-objective optimization was carried out using a non-dominated sorting genetic algorithm integrated with finite element analysis of the hemipelvises subject to various loading conditions of common daily activities. The optimal functionally graded porous designs (OFGPs -1, -2, -3, -4, -5) exhibited less strain-shielding in cancellous bone compared to solid metal-backing. Maximum bone-implant interfacial micromotions (63-68 μm) for OFGPs were found to be close to that of solid metal-backing (66 μm), which might facilitate bone ingrowth. However, OFGPs exhibited an increase in volumetric wear (3-10 %) compared to solid metal-backing. The objective functions were found to be more sensitive to changes in polar gradation exponent than radial gradation exponent, based on the Sobol' method. Considering the common failure mechanisms, OFGP-1, having highly porous acetabular rim and less porous dome, appears to be a better alternative to the solid metal-backing.
- ArticleLoong SK, Tan KK, Zulkifle NI, AbuBakar S.Data Brief. 2019 Aug;25:104159.Paraburkholderia fungorum is an opportunistic bacteria infrequently associated with human infections. Here, we report the draft genome sequence of P. fungorum strain BF370, recovered from the synovial tissue of a patient in Malaysia. The P. fungorum genome contains a 8,950,957 bp chromosome with a G+C content of 61.8%. Colicin and heavy metal resistant genes were also present in the genome. Conserved sequence indels unique to P. fungorum were observed in the genome. The draft genome was deposited at the European Nucleotide Archive under the sample accession number ERS1776561 and study accession number PRJEB17921.
- ArticleSaadh MJ, Pecho RDC, Jamal A, Alothaim AS, Kamal MA, Warsi MK, Ahmad F, Obaid M, Moslem H, Zainab HA, Amin AH, Arias-Gonzáles JL, Margiana R, Akhavan-Sigari R.J Reprod Immunol. 2023 12;160:104159.Oligospermia and asthenozoospermia, both frequent, can lead to male infertility. Oligospermia might be viewed as a milder form of azoospermia because the same mutations that produce azoospermia in some individuals also create oligospermia in other individuals. In this, we looked at different characteristics of oligospermia men, counting the level of apoptosis and a few related apoptotic and oxidative stress components, and compared them to solid controls. In this study, semen samples from healthy fertile men (n = 35) and oligospermia (n = 35) were collected, and sperm death rates in both groups were examined using flow cytometry. Also, gene expression of apoptotic and anti-apoptotic markers and miR-221 were investigated (Real-Time PCR). Moreover, for the evaluation of catalase and SOD activity and anti-inflammatory cytokines, including IL-10 and TGF-β, the specific ELISA kits and procedures were applied. As a result, higher gene and protein expression levels of PTEN, P27, and P57 were observed in patients with oligospermia. In contrast, lower mRNA expression of AKT and miR-221 was detected in this group. In addition, IL-10, TGF-β, and catalase activity were suppressed in the oligospermia group compared with healthy men samples. Moreover, the frequency of apoptosis of sperm cells is induced in patients. In conclusion, apoptosis-related markers, PTEN, and the measurement of significant and efficient oxidative stress markers like SOD and catalase in semen plasma could be considered as the critical diagnostic markers for oligospermia. Future studies will be better able to treat oligospermia by showing whether these indicators are rising or falling.
- ArticleZabag R, Gilboa-Schechtman E, Levy-Gigi E.Behav Res Ther. 2022 10;157:104159.Social anxiety (SA) was associated with biases in the updating of self-related information. Whether and under which conditions such biases emerge with respect to other-related information remains under-explored. In a pre-registered study, online participants (n = 590) were randomly assigned to one of two structurally identical reversal-learning tasks with social (faces) or non-social (shapes) stimuli. In the initial phase of this task, stimulus-outcome associations were learned by trial and error. Next, in the updating phase of the task, these associations were modified. SA was associated with reduced negative-to-positive updating and enhanced positive-tonegative updating of social, but not non-social, information. The results extend previous studies suggesting that SA is associated not only with biased updating of selfrelated information but also with biased updating of other-related information. This bias is specific to social information and may contribute, along with other information processing biases, to the maintenance of SA.
- ArticleMustafa B, Ehsan M, Ayyan M, Ashraf A, Athar F.Ann Med Surg (Lond). 2022 Aug;80:104159.
- ArticleLaw SM, Zheng JJ.iScience. 2022 Apr 15;25(4):104159.Wnt signaling pathways have been extensively studied in the context of several diseases, including cancer, coronary artery disease, and age-related disorders. β-Catenin plays a central role in the most studied Wnt pathways, the Wnt/β-catenin signaling pathway, commonly referred to as the canonical Wnt signaling pathway. β-catenin is a substrate of glycogen synthase kinase 3β (GSK-3β), and the phosphorylated β-catenin by GSK-3β can be degraded by the proteasome through ubiquitination. Thus, GSK-3β inhibitors have become a widely used chemical biology tool to study the canonical Wnt signaling pathway. Among the varied GSK-3β inhibitors, a compound known as CHIR-99021 is one of the most widely used. Although these inhibitors contribute greatly to our understanding of the canonical Wnt pathway, certain pitfalls associated with such an approach may have been overlooked. In many published studies, micromolar concentrations of CHIR-99021 are used to activate the canonical Wnt pathway. Although CHIR-99021 is a specific GSK-3β inhibitor, it specifically inhibits the kinase at the nanomolar level. Therefore, caution is required when micromolar levels of CHIR-99021 are used for the purpose of activating the canonical Wnt signaling pathway.
- ArticleToomer OT, Redhead AK, Vu TC, Santos F, Malheiros R, Proszkowiec-Weglarz M.Poult Sci. 2024 Nov;103(11):104159.The consumption of poultry products contaminated with Salmonella species is one of the most common causes of Salmonella infections. In vivo studies demonstrated the potential application of peanut skins (PS) as an antimicrobial poultry feed additive to help mitigate the proliferation of Salmonella in poultry environments. Tons of PS, a waste by-product of the peanut industry, are generated and disposed in U.S. landfills annually. Peanut skins and extracts have been shown to possess antimicrobial and antioxidant properties. Hence, we aimed to determine the effect of PS as a feed additive on the gut microbiota of broilers fed a control or PS supplemented (4% inclusion) diet and inoculated with or without Salmonella enterica Enteritidis (SE). At hatch 160 male broilers were randomly assigned to 4 treatments: 1) CON-control diet without SE, 2) PS-PS diet without SE, 3) CONSE-control diet with SE, 4) PSSE-PS diet with SE. On d 3, birds from CONSE and PSSE treatments were inoculated with 4.2 × 109 CFU/mL SE. At termination (4 wk), 10 birds/treatment were euthanized and ileal and cecal contents were collected for 16S rRNA analysis using standard methodologies. Sequencing data were analyzed using QIIME2. No effect of PS or SE was observed on ileal alpha and beta diversity, while evenness, richness, number of amplicon sequence variants (ASV) and Shannon, as well as beta diversity were significantly (P < 0.05) affected in ceca. Similarly, more differentially abundant taxa between treatment groups were identified in ceca than in ileum. However, more microbiota functional changes, based on the PICRUST2 prediction, were observed in ileum. Overall, relatively minor changes in microbiota were observed during SE infection and PS treatment, suggesting that PS addition may not attenuate the SE proliferation, as shown previously, through modulation of microbiota in gastrointestinal tract. However, while further studies are warranted, these results suggest that PS may potentially serve as a functional feed additive for poultry for improvement of animal health.
- ArticlePastuszak M, Cubała WJ, Kwaśny A.Asian J Psychiatr. 2024 Sep;99:104159.Symptoms that emerge during pharmacological treatment of bipolar depression are frequently observed, underscoring the necessity for comprehensive treatment monitoring. This observational study sought to observe the correlation of eight intravenous ketamine infusions with treatment-emergent depressive symptoms in treatment-resistant bipolar depression patients who maintained their baseline psychotropic and chronic somatic treatments. Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Treatment-emergent symptoms TES were defined as symptoms absent at baseline but present at the conclusion of the study. The most common TES included decreased appetite, increased weight, hypersomnia, and diurnal mood variation. Conversely, feelings of sadness, altered perceptions of the future, decreased interest in sex, and physical discomfort were absent in all patients. Notably, 13.6 % of patients reported thoughts of death or suicide. Larger-scale studies, integrating clinician-rated and patient-reported outcome measures, are essential to deepen our understanding of treatment-emergent symptoms. Establishing regulatory or professional definitions for treatment-emergent symptoms is warranted to improve the robustness of future research endeavors.
- ArticleAlbatat M, Arevalo H, Bergsland J, Strøm V, Balasingham I, Odland HH.Comput Biol Med. 2021 01;128:104159.Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.
- ArticleRayner J, Khan T, Chan C, Wu C.Int J Med Inform. 2020 08;140:104159.BACKGROUND: Although barriers exist to secondary use of primary care electronic medical record (EMR) data, the Alliance for Healthier Communities (the Alliance) in Ontario, Canada has successfully created one of the largest structured primary care EMR datasets in Canada. In 2018, the Alliance and the Canadian Institute for Health Information (CIHI), an organization that provides comparable and actionable data to accelerate improvements in health across Canada, entered into a partnership to share EMR data. In this paper, we describe (i) the processes that enabled the collection of structured EMR data by the Alliance; (ii) how CIHI connected with the Alliance to share data and assess its quality; and, (iii) demonstrate the value of linking structured EMR data to administrative acute care data in illustrating the patient journey through the care continuum, using COPD as a case study.
METHODS: CIHI and the Alliance entered into a formal data sharing agreement that enabled the sharing of linkable structured EMR data by the Alliance's 75 community health centres (CHCs) with CIHI. By leveraging the Alliance's Business Intelligence Reporting Tool, 3 years of EMR data containing patient-level clinical data were shared with CIHI. CIHI assessed the EMR data quality using its Data Source Assessment Tool to ensure fitness for analytical use. By linking the patient level EMR records with hospital records (CIHI's discharge abstract database (DAD) and the national ambulatory care reporting system (NACRS)), we examined aspects of COPD patient management in primary care and followed their journey through the health care continuum, including follow-up in primary care after hospital discharge.
RESULTS: Alliance EMR data representing approximately 570,000 patients and 8.5 million primary care encounters between April 1, 2015 and March 31, 2018 were shared with CIHI. A data quality assessment, centered on completeness and concordance, confirmed that the data was fit for analytical purposes. Overall, 13,023 enrolled primary care patients were identified as having COPD, representing an overall crude prevalence of 8.7%. The average age of COPD patients was 64 years and equally affected males and females. Patients were most likely to have completed high school education or equivalent, speak English, live alone, and have a household income less than $15,000. They most commonly had between 10-19 primary care encounters a year with a range of providers where they most commonly sought services for health advice/ instructions, to discuss their treatment plans and for medication renewals. By linking the EMR data to CIHI's NACRS and DAD, we found that 74.1% of COPD patients had at least one ED visit and that 34.4% of COPD patients had at least one acute care hospitalization during the study period. Further, 16.2% of ED visits resulted in an acute care hospital admission. Of those hospitalized, the majority of COPD patients were discharged home (81.6%) and received timely follow-up in primary care (81.0% within 30 days).
CONCLUSION: Structured and linkable EMR data provides opportunities to examine the patient journey through the care continuum in an innovative way. Using structured EMR data from the Alliance, linked with CIHI's NACRS and DAD databases, we were able to generate a cohort of patients with COPD, explore the complexities of their primary care encounters and follow them through the continuum of care, namely emergency department visits and hospitalizations. It is hoped that the partnership between the Alliance and CIHI will help drive future efforts on addressing the gap in comparable EMR data in Canada, and internationally.