Dose Information Research Articles

O-20 Predictions of systemic drug exposure to gabapentin and tramadol following administration to children

Background Gabapentin and tramadol are drugs com-monly used in various treatment of pain in adults. Gab-apentin has been successfully given for neuropathic pain and has been used off-label to treat children with the same condition. Tramadol has been licensed for the use in children older than 1 month in some European coun-tries, but its use has been limited to children>12 years. The management of chronic pain in paediatric patients is burdened by the insufficiency of clinical information, therefore, in order to investigate appropriate dosing for this population, pharmacokinetic (PK) modelling and simulation of virtual patient groups is a most useful ap-proach. In this study we report the analyses used to characterise the population PK and corresponding hier-archical models that are required to provide an adequate description of the time course and variability of drug con-centrations in plasma. Methods Non-linear, mixed-effect modelling was used to simulate the plasma concentrations of gabapentin and tramadol in subjects between the ages of 3 months and 18 years, under the assumption of comparable ex-posure-response relationships in adult and paediatric patients. Previously published PK models in paediatric pa-tients by Ouellet et al1 and Garrido et al2 were chosen and adapted for gabapentin and tramadol, respectively. Dosing regimens for both drugs were evaluated in a co-hort of virtual patients, based upon off-label doses used empirically. The population for the simulations was con-structed using data from the NHANES database; individu-al body weight was the primary covariate factor affecting PK disposition. The exposure (AUC) and Cmax parameters were derived from the simulated plasma concentrations, to compare with efficacious adult levels. Both drugs are titrated to a maximum dose over a period of 3 weeks, giv-en three times daily. Results The desired exposure in children should be comparable to the median value obtained for area under the concentration vs. time curve at steady state. An adult AUC range of 25 mg/L*h to 75 mg/L*h corresponded to gabapentin dosing at 63 mg/kg/day and 45 mg/kg/day in patients weighing 5–15 kg and >15 kg, respectively (after a three week titration). Mean plasma concentrations of between 200–300 ng/mL were chosen as a target level for tramadol, and a titration scheme over a three week period up to a maximum of 8 mg/kg/day proceeded to achieve safe dosing. At the end of the titration phase, all weight groups showed drug exposure in the range shown to be safe and effective for the proposed regimens. Conclusion Clinical trial simulations showed how the proposed dosing regimens yielded suitable drug expo-sure in paediatric populations, suggesting a solution to the issue of under-or over-dosing in this subgroup, and informing appropriate dosage information. This informa-tion contributes to avoiding unnecessary adverse events or, conversely, ineffective treatment.

Clinical application features of Fufang Kushen injection in treating malignant esophageal tumor： real world study based on hospital information system

To analyze the clinical application features of Fufang Kushen injection in treating malignant esophageal tumors in the real world by using hospital information system database, and provide reference for clinical application of Fufang Kushen injection. The electronic medical data from 2 550 patients with malignant esophageal tumors using Fufang Kushen injection from 22 large-scale hospitals nationwide were extracted based on the hospital information system (HIS) established by Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences. Then the descriptive analysis based on frequency and rate was conducted for general characteristics, diagnostic characteristics, characteristics of dosage and medication information, characteristics of drug combination, and discharge outcome characteristics. The results showed that the average age of patients treated with Fufang Kushen injection for malignant esophageal tumors was 62.3 years old; more males than females; admitted to hospital mainly in department of cardiology, oncology and digestology first. The total efficiency was 47.15% based on the discharge outcome characteristics; the most common dosage was 10-20 mL for single use; the course of treatment was mainly 4-7 d; and the common drugs in drug combinations included dexamethasone, tropisetron injection, thymosin injection, compound amino acid injection, pantoprazole sodium injection, fluorouracil, et al. The characteristics of the crowd using Fufang Kushen injection to treat the malignant esophageal tumors were clear and in line with the general rule of malignant esophageal tumors; its clinical dosage and scope of treatment for malignant esophageal tumors in the real world were basically consistent with the specification; and the types of clinical drug use combinations were more extensive.

Pertinence comparée des notifications d’effets indésirables de patients et professionnels de santé

Drug-induced adverse events have been accessible to patient's spontaneous reporting in France and such notifications have been steadily increasing since 2011. However, these notifications are still shrouded with medical perplexity and are sometimes subjected to partial caution in their interpretation by the patient's physician. We aimed to evaluate and compare prospectively the relevance of such spontaneous notifications with those provided by healthcare professionals to the French Pharmacovigilance Center of Nice-Alpes-Côte d'Azur. Spontaneous reporting of drug adverse events notified by patients and health care professionals were compared in terms of critical (name, date, effect, drug involved, chronological compatibility) and non-critical (posology, dosage) information, whereas the plausibility of the cases were assessed in weekly multispecialty staffs. Each patient's notification was matched with the immediate pre- and post-notifications declared by health care providers. Spontaneous notifications from 61 patients were compared with 122 notifications from health care providers. Neither the critical information necessary for declaring the case in the national database (7/61 versus 16/122, P=0.75), nor the uncritical elements allowing to assess the case (30/61 versus 51/122, P=0.22), its plausibility or the causality of the drug (P=0.10) differed significantly between the two groups. 107 cases out of 122 (88%) notified by health care providers were classified as serious, as compared with 19 out of 61 (15%) of patient's ones (P<0.001). Despite concerns from pharmacovigilance specialists in France, the medical relevance of spontaneous reported drug-associated adverse events does not differ from that of health care providers.

Linkage map construction and QTL analysis for internal heat necrosis in autotetraploid potato

A tetraploid potato population was mapped for internal heat necrosis (IHN) using the Infinium ® 8303 potato SNP array, and QTL for IHN were identified on chromosomes 1, 5, 9 and 12 that explained 28.21% of the variation for incidence and 25.3% of the variation for severity. This research represents a significant step forward in our understanding of IHN, and sets the stage for future research focused on testing the utility of these markers in additional breeding populations. Internal heat necrosis (IHN) is a significant non-pathogenic disorder of potato tubers and previous studies have identified AFLP markers linked to IHN susceptibility in the tetraploid, B2721 potato mapping population. B2721 consists of an IHN susceptible×resistant cross: Atlantic×B1829-5. We developed a next-generation SNP-based linkage map of this cross using the Infinium® 8303 SNP array and conducted additional QTL analyses of IHN susceptibility in the B2721 population. Using SNP dosage sensitive markers, linkage maps for both parents were simultaneously analyzed. The linkage map contained 3427 SNPs and totaled 1397.68cM. QTL were detected for IHN on chromosomes 1, 5, 9, and 12 using LOD permutation thresholds and colocation of high LOD scores across multiple years. Genetic effects were modeled for each putative QTL. Markers associated with a QTL were regressed in models of effects for IHN incidence and severity for all years. In the full model, the SNP markers were shown to have significant effects for IHN (p<0.0001), and explained 28.21% of the variation for incidence and 25.3% of the variation for severity. We were able to utilize SNP dosage information to identify and model the effects of putative QTL, and identify SNP loci associated with IHN resistance that need to be confirmed. This research represents a significant step forward in our understanding of IHN, and sets the stage for future research focused on testing the utility of these markers in additional breeding populations.

Real-world health care utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir ® HFA) with and without integrated dose counters.

BackgroundAccurate tracking of the administered dose of asthma rescue inhalers is critical for optimal disease management and is related to reductions in rates of unscheduled health care utilization in asthma patients. There are few published data on the real-world impact of rescue inhalers with integrated dose counters (IDCs) on health care resource utilization (HRU) for asthma patients. This study evaluates HRU among users of ProAir® hydrofluoroalkane (HFA) (albuterol sulfate inhalation aerosol), with IDC versus without IDC, in asthma patients.MethodsThis was a retrospective administrative claims study of asthma patients receiving a new prescription for albuterol inhalation aerosol without IDC during 2 years (January 2011–December 2012) or with IDC during the first full year after IDC implementation in the USA (July 2013–July 2014). Six months of continuous enrollment with medical and prescription drug benefits were required before and after the first prescription during the study period. Data on respiratory-related hospitalizations and emergency department (ED) visits were collected during the follow-up period.ResultsA total of 135,305 (32%) patients used albuterol inhalation aerosol with IDC, and 287,243 (68%) patients received albuterol inhalation aerosol without IDC. After adjusting for baseline confounding factors, the odds ratio (OR) for experiencing a respiratory-related hospitalization (OR=0.92; 95% confidence interval [CI] 0.88–0.96) or ED visit (OR=0.92; 95% CI 0.90–0.94) was significantly lower among patients using albuterol inhalation aerosol with IDC versus without IDC.ConclusionIn a real-world setting, asthma patients using ProAir HFA with IDC experienced significantly fewer hospitalizations and ED visits compared with patients using ProAir HFA without IDC. Dosage information provided by IDCs may allow providers to better understand patients’ disease severity and aid in titrating controller medications and also decrease the likelihood that the canister will be empty when needed, thereby enhancing disease management and reducing HRU.

Evaluating the care received by patients with oesophago-gastric (OG) cancer: the richer picture provided by linked datasets

ABSTRACTObjectivesThe national oesophago-gastric cancer audit evaluates the care given to patients with OG cancer diagnosed in England and Wales, identifying areas for local services to improve and so achieve better patient outcomes. While the audit follows a standard approach by collecting a core dataset, it extends this by linking to other national databases in order to (1) reduce the burden of data collection, (2) add data that could not otherwise be obtained, (3) verify the quality of audit data. This presentation will provide an overview of the modern approach to national clinical audits and introduce anticipated future developments.&#x0D; ApproachThe data collected by hospitals and submitted to the audit is expanded by linkage to radiotherapy data (RTDS), date of death from the Office for National Statistics and administrative hospital admission data (HES). The linked data enables the Audit to: (1) examine whether radiotherapy regimens used in definitive oncology comply with guideline recommendations, using dosage information drawn from RTDS; (2) publish comparative short-term survival figures for NHS trusts and surgeons using ONS date of death; and (3) assess the quality of data submitted from hospitals by comparing coded procedural information in HES and the audit dataset.&#x0D; ResultsThe analysis of the linked data has led to several important audit findings, namely: (1) Access to RTDS data confirmed reasonable compliance with official guidelines on recommended radiotherapy dosing schedules. (2) Linked mortality data has provided robust and credible estimates of surgical outcomes and is a critical output to NHS trusts and surgeons, as well as the wider public. Our analysis has highlighted a gradual decline in post-operative mortality. (3) Linkage of audit and HES data identified gaps in the recording of endoscopic stenting, with many procedures not being submitted by participating trusts. These diverse results underline the usefulness of linked data in revealing a more complete picture of the care received by OG cancer patients.&#x0D; ConclusionLinked data has become integral for the successful implementation of a national clinical audit, supplementing the core dataset with information that would otherwise be unavailable or difficult and costly to collect. Linkage enhances the audit’s ability to assess health services’ compliance with professional standards and to give service providers the opportunity to benchmark their performance. Future developments are expected to expand on this by including primary care service use before diagnosis.

Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

QTL mapping of potato chip color and tuber traits within an autotetraploid family

Cultivated potato (Solanum tuberosum L.) is a highly heterozygous autotetraploid crop species, and this creates challenges for traditional line development and molecular breeding. Recent availability of a single-nucleotide polymorphism (SNP) array with 8303 features and software packages for linkage and association mapping in autotetraploid species present new opportunities for the identification of genomic regions that contribute to high-value traits in cultivated potato. A biparental tetraploid potato population was evaluated across three field seasons and storage trials in order to identify quantitative trait loci (QTL) for multiple tuber traits including fried chip color after 5.5–7.2 °C storage. Tetra-allelic dosage information was used to construct a genetic linkage map that covered 1041 cM and contained 2095 SNP markers with a median marker interval of 0.4 cM. A total of 41 QTL were identified for flower color, tuber yield, tuber number per plant, tuber weight, tuber size, and chip color after various storage regimes. Moderate effect QTL for chip color at 3 months were identified that co-localized with candidate genes vacuolar invertase (VInv), invertase inhibitor (INH2), and apoplastic invertase (Inv ap -b). A separate QTL for chip color after 6 months of storage was identified in the short arm of chromosome 2, and this locus may contribute to variation in senescent sweetening resistance. QTL for tuber weight, length, and width co-localized with a known QTL for plant maturity on chromosome 5. Genome-wide association mapping using a polyploid model detected the tuber size QTL and identified a number of candidate SNPs, but was unable to detect markers significantly associated with chip color.

A Novel Scale Linking Potency and Dosage to Estimate Anticholinergic Exposure in Older Adults: the Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale.

Quantification of the anticholinergic exposure insufficiently or imprecisely incorporates dosage information, leading to inaccurate estimations. The aim was to construct a novel scale, including potency and dosage for the quantification of the anticholinergic exposure in older adults. Potency information was retrieved from a previous systematic review. The dosage range for each drug was delineated in minimal, maintenance and maximal dosage for adults and older adults. Dosage information was collected from authoritative sources and reviewed in an expert panel. The Muscarinic Acetylcholinergic Receptor ANTagonist Exposure (MARANTE) scale was tested for clinimetric properties using cohorts of community-dwelling older adults and nursing home residents. After three data collection rounds, data for the dosage ranges remained incomplete for 32 active substances. Remaining gaps were filled in, and 11 dosage adjustments were proposed during the expert panel meeting. We chose the values {0; 1; 2) for the categories of potency and {0; 0.5; 1; 1.5; 2) for the levels of dosage ranges, showing good clinimetric properties. Forty-one anticholinergic drugs were prescribed in the two cohorts. Most (61%) were low potency anticholinergics and used for depression (19%, e.g. citalopram). There were 31.8% (median MARANTE 1.5, IQR 1.5-2.5) and 37.6% (median 2, IQR 1.5-2.5) anticholinergic users in the community-dwelling cohort and nursing home cohort, respectively. The MARANTE scale combines potency with the dosage spectrum, to quantify the anticholinergic exposure in older adults. An open feedback system on the list of anticholinergic and proposed anticholinergic potency and dosage values is advised.

Mechanisms for Successful Rehabilitation of Cough in Parkinson's Disease Using Expiratory Muscle Strength Training

Rehabilitation of cough is now moving under the purview of speech-language pathology as our understanding of the relationship between disorders of cough and swallow increases. The purpose of this review is to provide a guide in understanding the mechanisms of weak or disordered cough in Parkinson's disease, and mechanisms for why expiratory muscle strength training is an effective therapy. Additionally, this review provides resources for performing clinical evaluations of maximum expiratory pressure and dosage information for expiratory muscle strength training.

Commentary on Vrolijk et al. (2017): The paradox of the quality control problem.

Commentary on Vrolijk et al. (2017): The paradox of the quality control problem.

Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

Objective To assess associations between risks of cardiovascular disease, heart failure, and all cause mortality and different diabetes drugs in people with type 2 diabetes, particularly newer agents, including gliptins...

Clinical Psychopharmacology Update: What's in a Name? Confusion Prompts Change for Vortioxetine's Brand Name

Similar names between two unrelated drugs have led the FDA to issue warnings about and now approve a name change for vortioxetine, which was branded as Brintellix® until recently. While the trade name had been screened prior to the product's launch, the FDA received numerous reports of prescribing and dispensing errors, specifically with regard to the anti-coagulant drug Brilinta® (ticagrelor). Starting 1 June 2016, vortioxetine will be marketed under the name Trintellix™ in an effort to reduce confusion. Clinicians are advised that while the name and National Drug Code number with this product will change, it will retain the same formulation, indication, and dosage information. To the extent possible, clinicians can and should take actions to identify and reduce potential medication errors in prescriptions, especially when using electronic records and e-prescription systems.

TarSVM: Improving the accuracy of variant calls derived from microfluidic PCR-based targeted next generation sequencing using a support vector machine.

BackgroundTargeted sequencing of discrete gene sets is a cost effective strategy to screen subjects for monogenic forms of disease. One method to achieve this pairs microfluidic PCR with next generation sequencing. The PCR step of this pipeline creates challenges in accurate variant calling. This includes that most reads targeting a specific exon are duplicates that have been amplified from the PCR step. To reduce false positive variant calls from these experiments, previous studies have used threshold-based filtering of alternative allele depth ratio and manual inspection of the alignments. However even after manual inspection and filtering, many variants fail to be validated via Sanger sequencing. To improve the accuracy of variant calling from these experiments, we are challenged to design a variant filtering strategy that sufficiently models microfluidic PCR-specific issues.ResultsWe developed an open source variant filtering pipeline, targeted sequencing support vector machine (“tarSVM”), that uses a Support Vector Machine (SVM) and a new score the normalized allele dosage test to identify high quality variants from microfluidic PCR data. tarSVM maximizes training knowledge by selecting variants that are likely true and likely false variants by incorporating knowledge from the 1000 Genomes and the Exome Aggregation Consortium projects. tarSVM improves on previous approaches by synthesizing variant features from the Genome Analysis Toolkit and allele dosage information. We compared the accuracy of tarSVM versus existing variant quality filtering strategies on two cohorts (n = 474 and n = 1152), and validated our method on a third cohort (n = 75). In the first cohort, our method achieved 84.5 % accuracy of predicting whether or not a variant would be validated with Sanger sequencing versus 78.8 % for the second most accurate method. In the second cohort, our method had an accuracy of 73.3 %, versus 61.5 % for the second best method. Finally, our method had a false discovery rate of 5 % for the validation cohort.ConclusionstarSVM increases the accuracy of variant calling when using microfluidic PCR based targeted sequencing approaches. This results in higher confidence downstream analyses, and ultimately reduces the costs Sanger validation. Our approach is less labor intensive than existing approaches, and is available as an open source pipeline for read trimming, aligning, variant calling, and variant quality filtering on GitHub at https://github.com/christopher-gillies/TargetSpecificGATKSequencingPipeline.Electronic supplementary materialThe online version of this article (doi:10.1186/s12859-016-1108-4) contains supplementary material, which is available to authorized users.

Hearing Health in College Instrumental Musicians and Prevention of Hearing Loss.

College musicians exhibit greater declines in hearing than the general population and are at particular risk because they rehearse and perform daily in loud environments. Also, they engage in use of personal listening devices which increases the amount of "exposure" time. Despite increased risk, many do not use hearing protection devices (HPD). The purpose of this study was to (1) to identify the present level of education about hearing health, (2) identify the perceived advantages and disadvantages of using HPD, and (3) evaluate results among different musical instrument groups. A mixed-methods group design was used including both quantitative and qualitative instruments. SPSS was used to generate descriptive statistics, and non-parametric statistical analysis was performed on quantitative data. NVivo software was used to evaluate qualitative responses. Of the 90 college instrumental music students who participated, 12% reported a history of hearing loss, and over one-third reported tinnitus. Seventy-seven percent of participants had never received any training about hearing health and only a small percentage of students used HPD. The most cited reason for lack of protection use was its negative impact on sound quality. However, group differences were noted between brass, woodwind, and percussion musicians in terms of HPD uptake. Improving the type of information disseminated to college musicians may reduce the risk of ear-related deficits. Noise dosage information, HPD information, and prevention education grounded in theories like the Health Belief Model may increase awareness and promote greater use of HPDs in this population.

Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum.

Synthetic oxytocin (synOT) is commonly used in labor management to induce and augment labor, and to prevent postpartum hemorrhage. However, its long-term consequences for maternal health and behavior are largely understudied. We examined the relationship between synOT and maternal oxytocin levels, breastfeeding, and maternal mental health at 2 months postpartum. Women were recruited during pregnancy or within 48 hours of giving birth through obstetric practices and hospitals. A total of 386 women were visited in their homes at 2 months postpartum, where they completed questionnaires assessing breastfeeding, depression, anxiety, posttraumatic stress, and somatization. Oxytocin levels were obtained from blood samples and synOT dosage information was gathered from hospital charts. Intrapartum synOT dose was positively correlated with endogenous oxytocin levels at 2 months postpartum. Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress. The widespread use of synOT in managed labor warrants caution, as the influence of synOT on a new mother's well-being is evident at 2 months postpartum.

Genetic Linkage Mapping of Economically Important Traits in Cultivated Tetraploid Potato (Solanum tuberosum L.).

The objective of this study was to construct a single nucleotide polymorphism (SNP)-based genetic map at the cultivated tetraploid level to locate quantitative trait loci (QTL) contributing to economically important traits in potato (Solanum tuberosum L.). The 156 F1 progeny and parents of a cross (MSL603) between “Jacqueline Lee” and “MSG227-2” were genotyped using the Infinium 8303 Potato Array. Furthermore, the progeny and parents were evaluated for foliar late blight reaction to isolates of the US-8 genotype of Phytophthora infestans (Mont.) de Bary and vine maturity. Linkage analyses and QTL mapping were performed using a novel approach that incorporates allele dosage information. The resulting genetic maps contained 1972 SNP markers with an average density of 1.36 marker per cM. QTL mapping identified the major source of late blight resistance in “Jacqueline Lee.” The best SNP marker mapped ∼0.54 Mb from a resistance hotspot on the long arm of chromosome 9. For vine maturity, the major-effect QTL was located on chromosome 5 with allelic effects from both parents. A candidate SNP marker for this trait mapped ∼0.25 Mb from the StCDF1 gene, which is a candidate gene for the maturity trait. The identification of markers for P. infestans resistance will enable the introgression of multiple sources of resistance through marker-assisted selection. Moreover, the discovery of a QTL for late blight resistance not linked to the QTL for vine maturity provides the opportunity to use marker-assisted selection for resistance independent of the selection for vine maturity classifications.

EVALUATION OF MOBILE APPLICATION FOR ANTICOAGULANT DRUG MANAGEMENT: IOS AND ANDROID PLATFORM

Our goal was to identify the practical usage of medication management apps and what they can offer a consumer especially in their old age, keeping in view the aspect of medication adherence.A search of FREE medication management apps was conducted on app store of iPhone/Android operating system. Apps were included if they had a medication management system which included a reminder setup option and had an easy to use interface.Of the 22 apps on IOS and 18 apps on Android identified by strategy all met the inclusion criteria. WebMD and Drugs.com rated the highest among the apps because of their basic medication reminder feature coupled with their enhanced levels of functionality. WebMD was rated best for its information and usability which included a symptom checker, medication reminder, list of disease conditions, drug list with Indications, dosage information, side effects, drug interactions, drug use in pregnancy and lactation, first aid information, local health facilities listings, tests and procedures listings, healthy living tips, food and recipes.Finding a medication management app is challenging if you are looking for a specific type of apps as most of the apps are not tested by any authorized drug regulatory authority for example FDA. Almost all have no reviews and are not affiliated to any healthcare organization. Despite being untested, medication apps represent a possible strategy that pharmacists, healthcare workers, carers and family members of elderly patients can recommend for helping nonadherent patients and incorporate into their practice.

Cluster-randomized trial demonstrating impact on academic achievement of elementary social-emotional learning.

This study evaluated the results of a social and emotional learning (SEL) program on academic achievement among students attending a large, urban, high-risk school district. Using a cluster-randomized design, 24 elementary schools were assigned to receive either the intervention curriculum (Promoting Alternative Thinking Strategies, or PATHS) or a curriculum that delivered few if any SEL topics (i.e., the control group). In addition to state mastery test scores, demographic data, school attendance, and dosage information were obtained from 705 students who remained in the same group from the 3rd to the 6th grade. Analyses of odds ratios revealed that students enrolled in the intervention schools demonstrated higher levels of basic proficiency in reading, writing, and math at some grade levels. Although these between-groups differences held for race/ethnicity, gender, and socioeconomic status, significant within-group differences also were noted across these variables. Collectively, these findings indicated that social development instruction may be a promising approach to promote acquisition of academic proficiency, especially among youth attending high-risk school settings. Implications of these findings with respect to SEL programs conclude the article.

Medication Extraction from Electronic Clinical Notes in an Integrated Health System: A Study on Aspirin Use in Patients with Nonvalvular Atrial Fibrillation

PurposeThe purpose of this study was to investigate whether aspirin use can be captured from the clinical notes in a nonvalvular atrial fibrillation population. MethodsA total of 29,507 patients with newly diagnosed nonvalvular atrial fibrillation were identified from January 1, 2006, through December 31, 2011, and were followed up through December 31, 2012. More than 3 million clinical notes were retrieved from electronic medical records. A training data set of 2949 notes was created to develop a computer-based method to automatically extract aspirin use status and dosage information using natural language processing (NLP). A gold standard data set of 5339 notes was created using a blinded manual review. NLP results were validated against the gold standard data set. The aspirin data from the structured medication databases were also compared with the results from NLP. Positive and negative predictive values, along with sensitivity and specificity, were calculated. FindingsNLP achieved 95.5% sensitivity and 98.9% specificity when compared with the gold standard data set. The positive predictive value was 93.0%, and the negative predictive value was 99.3%. NLP identified aspirin use for 83.8% of the study population, and 70% of the low dose aspirin use was identified only by the NLP method. ImplicationsWe developed and validated an NLP method specifically designed to identify low dose aspirin use status from the clinical notes with high accuracy. This method can be a valuable tool to supplement existing structured medication data.