Systematized Nomenclature Of Medicine Clinical Terms Research Articles

Enhanced Cardiovascular Risk Assessment Incorporating Natural Language Processing and Qrisk-3 Score Determination in Patients with Essential Thrombocythaemia

Introduction: Fundamental to management of patients with essential thrombocythaemia (ET) is assessment, and reduction of thrombotic risk. We present a machine learning approach to summarise patient electronic health records (EHR) to determine prevalence of cardiovascular comorbidities and risk factors. We then review use of the QRISK-3 score to assess cardiovascular risk. Methods: We used a natural language processing (NLP) pipeline to identify mentions of hypertension (HTN), hypercholesterolaemia (HC), diabetes mellitus (DM), smoking (SM), unspecified thrombosis (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), myocardial infarction (MI) and stroke (CVA) in EHR. CogStack is an information retrieval and extraction architecture incorporating structured and unstructured EHR components. Data extracted from CogStack was processed by a medical concept annotation toolkit (MedCAT). MedCAT was used to disambiguate and capture synonyms and acronyms for Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) concepts. Using deep learning MedCAT determined linguistic and grammatical context such as negation, subject, and temporality. The base MedCAT model was trained in an unsupervised manner on >18 million EHR documents and this was further fine-tuned through 500 clinician annotated haematology documents. MedCAT mapped mentions of relevant concepts to respective SNOMED-CT codes and total counts were aggregated and grouped by individual patient. Manual validations were performed and an optimizer was applied to convert counts to a binary state by applying a threshold, above which a patient's condition was inferred to be present (Fig. i). QRISK-3 is an advanced validated score incorporating age, ethnicity, body mass index and other cardiovascular risk factors to determine 10-year cardiovascular risk in people aged 25-84. Results: 12905 documents from 560 ET patients were reviewed (median 20 per patient, IQR 8-34). In the manual validation dataset (n=120), MedCAT achieved excellent real-world F1 scores (model accuracy) for most concepts (HTN 0.91, HC 0.81, DM 1.0, VTE 0.73, CVA 0.87 and MI 0.67). Using a threshold of >2 mentions to define a positive population; HTN was identified in 21.3% (119) of patients, DM in 4.6% (26), MI in 3.6% (20), CVA in 7.7% (43), VTE in 8% (45), DVT in 1.4% (8), PE in 1.8% (10), PVT in 1.3% (7) and positive smoking status in 6.6% (37). HC was identified in 9.6% (54) using a threshold >1. 52% (28) of patients with HC and 69.2% (18) of those with DM also had HTN. Obesity was not identified in any patients using this approach. Patients with a diagnosis of HTN were more likely to have CVA than those without (15:104 vs 28:413, p=0.03). Patients with HTN were also more likely to have VTE (13:106 vs 19:422, p=0.01). Of patients with CVA/MI; 58.1% (25) /55% (11) had this event pre or at diagnosis and 30.2% (13)/ 10% (2) while receiving cytoreductive therapy. QRISK-3 analysis was performed in 32 patients with prior thrombosis and baseline criteria to evaluate predictive value; then 137 patients classified as low or intermediate (LIM) risk and not receiving cytoreductive therapy. Mean QRISK-3 was 8 in the thrombosis group, validating its relevance, and 2.5 (p<0.0001, Fig. ii) in the LIM cohort. Using the recognised QRISK-3 score threshold of >7.5 to define a high-risk population, 5.1% (7) patients from the LIM group were reclassified as high-risk due to additional comorbidities relevant to QRISK-3 including HTN in 8% (11), migraine 7.3% (10), DM 2.2% (3), severe mental illness 2.9% (4) and antipsychotic medication 0.7% (1). Discussion: We describe a novel approach to cardiovascular risk assessment in patients with ET, incorporating machine learning, allowing large volume data analysis, and detailed risk assessment using QRISK-3 scoring. We provide a rare ‘real-world’ report on the prevalence of comorbidities in this group, confirming increased CVA and VTE in patients with HTN. A previous report of 891 patients with ET showed prevalence of 5% for CVA, 2% for MI and 4% for VTE, suggesting that detection rate using our approach is within acceptable limits (Carobbio et al., Blood, 2011). Finally, as a novel finding, we show that QRISK-3 scoring is predictive of increased thrombotic risk and identifies a small group of patients who should be considered high-risk and may benefit from cytoreductive therapy, that are not detected using standard approaches.

Extracting cancer concepts from clinical notes using natural language processing: a systematic review

BackgroundExtracting information from free texts using natural language processing (NLP) can save time and reduce the hassle of manually extracting large quantities of data from incredibly complex clinical notes of cancer patients. This study aimed to systematically review studies that used NLP methods to identify cancer concepts from clinical notes automatically.MethodsPubMed, Scopus, Web of Science, and Embase were searched for English language papers using a combination of the terms concerning “Cancer”, “NLP”, “Coding”, and “Registries” until June 29, 2021. Two reviewers independently assessed the eligibility of papers for inclusion in the review.ResultsMost of the software programs used for concept extraction reported were developed by the researchers (n = 7). Rule-based algorithms were the most frequently used algorithms for developing these programs. In most articles, the criteria of accuracy (n = 14) and sensitivity (n = 12) were used to evaluate the algorithms. In addition, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) and Unified Medical Language System (UMLS) were the most commonly used terminologies to identify concepts. Most studies focused on breast cancer (n = 4, 19%) and lung cancer (n = 4, 19%).ConclusionThe use of NLP for extracting the concepts and symptoms of cancer has increased in recent years. The rule-based algorithms are well-liked algorithms by developers. Due to these algorithms' high accuracy and sensitivity in identifying and extracting cancer concepts, we suggested that future studies use these algorithms to extract the concepts of other diseases as well.

Concept Coverage Analysis of Ophthalmic Infections and Trauma among the Standardized Medical Terminologies SNOMED-CT, ICD-10-CM, and ICD-11

Widespread electronic health record adoption has generated a large volume of data and emphasized the need for standardized terminology to describe clinical concepts. Here, we undertook a systematic concept coverage analysis to determine the representation of clinical concepts in ophthalmic infection and ophthalmic trauma among standardized medical terminologies, including the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT), the International Classification of Diseases (ICD) version 10 with clinical modifications (ICD-10-CM), and ICD version 11 (ICD-11). Extraction of concepts related to ophthalmic infection and ophthalmic trauma and structured search in terminology browsers. The American Academy of Ophthalmology Basic and Clinical Science Course (BCSC), SNOMED-CT, and ICD-10-CM terminologies from the Observational Health Data Sciences and Informatics Athena browser, and the ICD-11 terminology browser. Concepts pertaining to ophthalmic infection and ophthalmic trauma were extracted from the 2022 BCSC free text and index terms. We searched terminology browsers to identify corresponding codes and classified the extent of semantic alignment as equal, wide, narrow, or unmatched in each terminology. The overlap of equal concepts in each terminology was represented in a Venn diagram. Proportions of clinical concepts with corresponding codes at various levels of semantic alignment. A total of 443 concepts were identified: 304 concepts related to ophthalmic infection and 139 concepts related to ophthalmic trauma. The SNOMED-CT had the highest proportion of equal coverage, with 82.0% (249 of 304) among concepts related to ophthalmic infection and 82.0% (115 of 139) among concepts related to ophthalmic trauma. Across all concepts, 28% (124 of 443) were classified as equal in ICD-10-CM and 52.8% (234 of 443) were classified as equal in ICD-11. The SNOMED-CT had significantly better semantic alignment than ICD-10-CM and ICD-11 for ophthalmic infections and ophthalmic trauma. This demonstrates opportunity for continuing advancement of representation of ophthalmic concepts in standardized medical terminologies.

Alzheimer Disease Occurs More Frequently In Patients With Inflammatory Bowel Disease: Insight From a Nationwide Study.

Alzheimer disease (AD) affects 5 million Americans and early recognition improves cognitive function. Chronic inflammation and gut microbiome alteration are linked to cognitive decline which are common in inflammatory bowel disease (IBD). We investigated the association of IBD with development of AD. A commercial database (Explorys Inc., Cleveland, OH), an aggregate of electronic health records from 26 major US health care systems, was surveyed. Cohorts of patients with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnoses of Crohn's disease (CD), ulcerative colitis (UC), and AD were identified. IBD patients with new diagnosis of AD were characterized based on demographic and traditional AD risk factors and IBD-related features. Among 342,740 IBD patients in the database, AD developed in 5750 IBD patients (1.55%). After adjusting for traditional AD risk factors, IBD was identified as an independent risk factor for development of AD [odds ratio (OR)=2.30, 95% confidence interval (CI)=2.10-2.51]. IBD patients with AD were younger in comparison to AD patients without IBD. On sub-group analysis, patients with CD had higher odds of developing AD (adjusted OR=3.34, 95% CI=3.25-3.42) than UC (adjusted OR=1.09, 95% CI=1.06-1.14). Use of tumor necrosis factor (TNF-α) inhibitors in IBD was associated with significantly lower odds of developing AD in both CD and UC. In this population based study, IBD was independently associated with development of AD. Among IBD; the association was stronger in patients with CD in comparison with UC. Use of TNF-α inhibitors was associated with lower odds of developing AD.

Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data.

Antidepressants exert an anticholinergic effect in varying degrees, and various classes of antidepressants can produce a different effect on immune function. While the early use of antidepressants has a notional effect on COVID-19 outcomes, the relationship between the risk of COVID-19 severity and the use of antidepressants has not been properly investigated previously owing to the high costs involved with clinical trials. Large-scale observational data and recent advancements in statistical analysis provide ample opportunity to virtualize a clinical trial to discover the detrimental effects of the early use of antidepressants. We primarily aimed to investigate electronic health records for causal effect estimation and use the data for discovering the causal effects of early antidepressant use on COVID-19 outcomes. As a secondary aim, we developed methods for validating our causal effect estimation pipeline. We used the National COVID Cohort Collaborative (N3C), a database aggregating health history for over 12 million people in the United States, including over 5 million with a positive COVID-19 test. We selected 241,952 COVID-19-positive patients (age >13 years) with at least 1 year of medical history. The study included a 18,584-dimensional covariate vector for each person and 16 different antidepressants. We used propensity score weighting based on the logistic regression method to estimate causal effects on the entire data. Then, we used the Node2Vec embedding method to encode SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) medical codes and applied random forest regression to estimate causal effects. We used both methods to estimate causal effects of antidepressants on COVID-19 outcomes. We also selected few negatively effective conditions for COVID-19 outcomes and estimated their effects using our proposed methods to validate their efficacy. The average treatment effect (ATE) of using any one of the antidepressants was -0.076 (95% CI -0.082 to -0.069; P<.001) with the propensity score weighting method. For the method using SNOMED-CT medical embedding, the ATE of using any one of the antidepressants was -0.423 (95% CI -0.382 to -0.463; P<.001). We applied multiple causal inference methods with novel application of health embeddings to investigate the effects of antidepressants on COVID-19 outcomes. Additionally, we proposed a novel drug effect analysis-based evaluation technique to justify the efficacy of the proposed method. This study offers causal inference methods on large-scale electronic health record data to discover the effects of common antidepressants on COVID-19 hospitalization or a worse outcome. We found that common antidepressants may increase the risk of COVID-19 complications and uncovered a pattern where certain antidepressants were associated with a lower risk of hospitalization. While discovering the detrimental effects of these drugs on outcomes could guide preventive care, identification of beneficial effects would allow us to propose drug repurposing for COVID-19 treatment.

Prevalence of non-alcoholic fatty liver disease in patients with nephrotic syndrome: A population-based study.

Non-alcoholic fatty liver disease (NAFLD) is a global health concern with a prevalence of about 25% amongst United States adults. Its increased prevalence is attributed to increase in patients with obesity and metabolic syndrome, partly due to similar mechanisms of injury. Nephrotic syndrome (NS) is a clinical entity resulting from extensive proteinuria leading to hypoalbuminemia, hyperlipidemia, edema, and other complications. Given its association with hyperlipidemia, there is concern that patients with NS may be at increased risk of NAFLD. To perform a cross-sectional population-based study to investigate the prevalence and risk factors of NAFLD in patients with NS. A large multicenter database (Explorys Inc., Cleveland, OH, United States) was utilized for this retrospective cohort study. A cohort of 49700 patients with a diagnosis of "Non-Alcoholic fatty liver disease" using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) between 1999-2022 was identified. Inclusion criteria were age ≥ 18 years, presence of NAFLD, presence of NS. There were no specific exclusion criteria. Univariate and multivariate analysis were performed to adjust for multiple risk factors including age, gender, Caucasian race, NS, type II diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease. Statistical analysis was conducted using R, and for all analyses, a 2-sided P value of < 0.05 was considered statistically significant. Among the 78734750 individuals screened in this database, there were a total of 49700 subjects with NAFLD. In univariate analysis, the odds of having NAFLD in patients with NS, type 2 diabetes mellitus, hypothyroidism, dyslipidemia, obesity, metabolic syndrome and chronic kidney disease were 14.84 [95% confidence interval (95%CI) 13.67-16.10], 17.05 (95%CI 16.78-17.32), 6.99 (95%CI 6.87-7.11), 13.61 (95%CI 13.38-13.84), 19.19 (95%CI 18.89-19.50), 29.09 (95%CI 28.26--29.95), and 9.05 (95%CI 8.88-9.22), respectively. In multivariate analysis, the odds of having NAFLD amongst patients with NS were increased to 1.85 (95%Cl 1.70-2.02), while the odds were also remained high in patients that have type 2 diabetes mellitus [odds ratio (OR) 3.84], hypothyroidism (OR 1.57), obesity (OR 5.10), hyperlipidemia (OR 3.09), metabolic syndrome (OR 3.42) and chronic kidney disease (OR 1.33). Patients with NS are frequently found to have NAFLD, even when adjusting for common risk factors. Hence, clinicians should maintain a high index of suspicion regarding presence of NAFLD in patients with NS.

MedLexSp – a medical lexicon for Spanish medical natural language processing

BackgroundMedical lexicons enable the natural language processing (NLP) of health texts. Lexicons gather terms and concepts from thesauri and ontologies, and linguistic data for part-of-speech (PoS) tagging, lemmatization or natural language generation. To date, there is no such type of resource for Spanish.Construction and contentThis article describes an unified medical lexicon for Medical Natural Language Processing in Spanish. MedLexSp includes terms and inflected word forms with PoS information and Unified Medical Language System^{circledR } (UMLS) semantic types, groups and Concept Unique Identifiers (CUIs). To create it, we used NLP techniques and domain corpora (e.g. MedlinePlus). We also collected terms from the Dictionary of Medical Terms from the Spanish Royal Academy of Medicine, the Medical Subject Headings (MeSH), the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT), the Medical Dictionary for Regulatory Activities Terminology (MedDRA), the International Classification of Diseases vs. 10, the Anatomical Therapeutic Chemical Classification, the National Cancer Institute (NCI) Dictionary, the Online Mendelian Inheritance in Man (OMIM) and OrphaData. Terms related to COVID-19 were assembled by applying a similarity-based approach with word embeddings trained on a large corpus. MedLexSp includes 100 887 lemmas, 302 543 inflected forms (conjugated verbs, and number/gender variants), and 42 958 UMLS CUIs. We report two use cases of MedLexSp. First, applying the lexicon to pre-annotate a corpus of 1200 texts related to clinical trials. Second, PoS tagging and lemmatizing texts about clinical cases. MedLexSp improved the scores for PoS tagging and lemmatization compared to the default Spacy and Stanza python libraries.ConclusionsThe lexicon is distributed in a delimiter-separated value file; an XML file with the Lexical Markup Framework; a lemmatizer module for the Spacy and Stanza libraries; and complementary Lexical Record (LR) files. The embeddings and code to extract COVID-19 terms, and the Spacy and Stanza lemmatizers enriched with medical terms are provided in a public repository.

Prevalence and Risk Factors Associated With Inflammatory Bowel Disease in Patients Using Proton-Pump Inhibitors: A Population-Based Study.

Background and aim Proton pump inhibitor (PPI) is a heavily prescribed medication in the United States that is used to treat several gastrointestinal disorders. Although it has been considered to besafe compared to other medications, multiple gastrointestinal side effects have been reported. These effects of PPIs might stemfrom the progressive alteration of the intestinal microbiome. Patients with inflammatory bowel disease (IBD) using PPI are also seen to be less likely to achieve remission. However, in the current literature, there is very little evidence of the risk of developing IBD in patients who have been using PPIs. Therefore, our aim was to perform a cross-sectional population-based study with in-depth analysis to assess the prevalence and risk factors of IBD amongst PPI users in the United States. Methodology A validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States was utilized to construct this study. A cohort of patients with a diagnosis of ulcerative colitis (UC) and Crohn's disease (CD) between 1999-2022 was identified using the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). Patients aged 18 to 65 years were included. We excluded any individual who had a diagnosis of chronic liver disease, autoimmune disease (excluding IBD), or cancer. The risk of IBD was calculated using a multivariate regression analysis to account for potential confounders includingnon-steroidal anti-inflammatory drugs (NSAIDs) use, smoking, patients who have had a diagnosis of alcoholism, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and metabolic syndrome. A two-sided P-value <0.05 was considered statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008). Results A total of 79,984,328 individuals were screened in the database and 45,586,150 patients were selected in the final analysis after accounting for inclusion and exclusion criteria.Using multivariate regression analysis, the risk of developing UC and CD was calculated. The odds of having UC amongst patientson PPI was 2.02 (95%CI 1.98-2.06), P-value <0.001.Similarly, the odds of having CD were high amongst PPI users (OR 2.79, 95%CI 2.75-2.84), P- value <0.001 Conclusion Our study demonstrates that patients on PPIs are frequently found to have UC and CD even when adjusting for common risk factors.Hence, we urge clinicians to be aware of this association in order to limit unnecessary prescriptions of PPIs, especially for patients who are at risk for autoimmune diseases.

The Risk of Cerebrovascular Accident in Patients with Myelodysplastic Syndrome in the United States: A Nationwide Population-Based Study

Introduction The natural history of myelodysplastic syndrome (MDS) is often complicated by thrombosis and hemorrhages due to quantitative and qualitative platelet anomalies. However, there is a dearth of real-world data regarding the risk of cerebrovascular accident (CVA) in the setting of MDS. This study focuses on assessing the risk of CVA among patients with MDS in the United States. Methods A retrospective study was performed using a large commercial US-based population database (Explorys, IBM) that aggregates records from 26 healthcare systems and includes over 80 million patients. Using Systematized Nomenclature of Medicine- Clinical Terms (SNOMED-CT), we identified adult patients (over 18 years old) diagnosed with MDS between 1999 and 2022. We examined the risk of CVA in these patients. Multivariable logistic regression was used to adjust for known variables associated with CVA such as sex, age > 65, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), tobacco use, atrial fibrillation (Afib), and the use of erythropoiesis-stimulating agents (ESA). Results A total of 70,502,300 patients were included in the analysis. 54, 950 patients were diagnosed with MDS; 53% were males, 84% were above the age of 65, 75% had underlying hypertension, 61% had hyperlipidemia, 36% had diabetes mellitus, 11% were smokers, and 31% had underlying atrial fibrillation (Table 1). The incidence of CVA during the study period among patients with MDS was 1.4%. After adjusting for possible confounding factors (Table 2), MDS was independently associated with a 1.47-fold increased risk of developing CVA (OR 1.47; 95% CI 1.39-1.54; P<0.001), compared with those without MDS. The risk of CVA was also significantly higher with the use of erythropoietin stimulating agents (OR 1.46; 95% CI 1.43-1.49, P<0.001). Conclusion This large real-world study demonstrated that MDS was an independent risk factor for CVA. With 47% higher odds, the risk is almost comparable to tobacco use. The use of erythropoiesis-stimulating agents in patients with MDS was another independent risk factor. The exact pathophysiology by which MDS increases the risk of arterial thrombosis has not yet elucidated. Further studies are needed to illustrate the possible underlying mechanisms which may lead to early interventions to decrease morbidity and mortality in this group of patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

PROTON PUMP INHIBITORS AND RISK OF PLEURAL EMPYEMA AND LUNG ABSCESS

PROTON PUMP INHIBITORS AND RISK OF PLEURAL EMPYEMA AND LUNG ABSCESS

S1045 Racial Disparities in Utilization of Medications in Inflammatory Bowel Disease Patients

Introduction: Inflammatory bowel disease (IBD) is traditionally associated with European ancestry but is increasingly seen among the different races and ethnicities in the United States. Large, multicenter studies across the US and Canada report more complex disease phenotypes among African American individuals. In our study, we explored the disparities in the treatment of IBD among the major racial groups in the United States. Methods: We used a multi-institutional database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of IBD (either Crohn’s disease (CD) or Ulcerative colitis (UC) between 1999 to present. Based on race, the study population was divided into two groups African American and Caucasian. The two groups were further categorized based on the type of medical therapy for IBD, such as thiopurines, methotrexate, 5-ASA, anti- tumor necrosis factor (anti-TNF), ustekinumab, and vedolizumab. Results: Of the 70,383,890 individuals in the database, we identified 249,420 (0.35%) patients with CD and 208,990 (0.30%) patients with UC. Among all IBD patients, 32,870 were African American (8 %) and 314,660 (76.2 %) were Caucasian. When compared with Caucasians, African American IBD patients were less likely to be treated with immunomodulator therapy such as 5-ASA [OR 0.86, p < 0.0001], methotrexate [OR 0.82, p < 0.0001] and thiopurines [OR 0.85, p < 0.0001] and immunosuppressant therapy with biologics such as anti-TNF [0.91, p < 0.0001], Ustekinumab [OR 0.78, p < 0.0001], Vedolizumab [OR 0.74, p < 0.0001] and Tofacitinib [OR 0.61, p =0.0044]. Conclusion: Our large cohort of IBD patients demonstrates significant healthcare disparity in the United States population. African American patients with IBD were significantly less likely to be treated with either immunomodulator or biologic therapy when compared to Caucasians. It is important for gastroenterologists to identify barriers to care in the African American IBD population and implement measures that can improve access to healthcare.Figure 1.: Forest plot of immunomodulators and biologic Therapy in race based-IBD patients. Univariate analysis used to calculated OR. The odds ratio in African Americans are based on whites as reference group. OR; odds ratio. CI; confidence interval. AA; African-American, TNFs; anti tumor necrosis factors, Thiopurines; azathioprine and mercaptopurine, MTX; Methotrexate. Table 1. - Univariate Logistic Regression of immunomodulators and biologic Therapy in race based-IBD patients AA IBD n=31,010 (%) Caucasian IBD n=259,320 (%) OR CI P-value Anti-TNFs 1,560 (5%) 18,460 (7.1%) 0.69 0.65-0.72 < 0.0001 Thiopurine 1,420 (4.5%) 17,090 (6.5%) 0.68 0.64-0.71 < 0.0001 Vedolizumab 300 (0.9%) 4,400 (1.6%) 0.56 0.50-0.63 < 0.0001 Ustekinumab 120 (0.3%) 1,640 (0.6%) 0.61 0.50-0.73 < 0.0001 Tofacitinib 30 (0.1%) 490 (0.2%) 0.51 0.35-0.74 = 0.0004 Methotrexate 620 (1.9%) 6,690 (2.5%) 0.777 0.70-0.83 < 0.0001 5-ASA 8,520 (26%) 90,830 (29%) 0.86 0.84-0.88 < 0.0001 OR; odds ratio. CI; confidence interval. AA; African-American, anti-TNFs; anti tumor necrosis factors, IBD; inflammatory bowel disease. 5-ASA; Mesalamine.

S1452 Metabolic Syndrome Is Not Associated With Mesenteric Ischemia

Introduction: Metabolic syndrome (MetS) is an increasingly prevalent pathological condition with multiple components such as insulin resistance, hyperlipidemia and increased abdominal adiposity. MetS has previously been associated with increased risk of coronary artery disease (CAD), myocardial infarction (MI), stroke and diabetes. It has been well established with many atherosclerotic processes, however its impact on the development of mesenteric ischemia has not been studied. The purpose of this study is to evaluate if an association between mesenteric ischemia and MetS exists. Methods: We queried a commercial database (Explorys Inc, Cleveland, OH) with electronic medical record data from 26 major U.S. healthcare systems. Adult patients ( >/=18 years old) with and without MetS between 1999 and 2021 were identified based on systematized nomenclature of medicine-Clinical Terms (SNOMED-CT). Differences in baseline characteristics and demographics were analyzed using chi-squared tests. Odds ratio analyses were performed between MetS and non-MetS patients for the presence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), coronary artery disease (CAD), peripheral vascular disease (PVD), myocardial infarction (MI), cerebrovascular accident (CVA). We defined P-values less than 0.05 to be statistically significant. Results: A total of 102,360 individuals were found to with and without MetS in the database. Of those patients, 1360 (1.3%) had MetS. MetS patients were more likely to be under the age of 65 (35.3% vs 20.9%, P< 0.0001), more likely to be female (66.9% vs 63.6%, P=0.0399), identified more commonly as White (84.6% vs 80.8%, P< 0.0001) and were more likely to be smokers (86.8% vs 71.5%, P< 0.0001). MetS patients were more likely to have CAD (OR: 1.65, P< 0.0001), PVD (OR: 1.99, P< 0.0001), MI (OR: 1.42, P< 0.0001) and CVA (OR:1.44, P< 0.0001) (Table). There was no difference in acute or chronic mesenteric ischemia. Conclusion: This study found no association between MetS and mesenteric ischemia but did have similar findings relating to other established cardiovascular conditions in other studies. This suggests that another atherosclerotic mechanism exists which contributes to mesenteric ischemia, particularly chronic mesenteric ischemia. Table 1. - Comparison of Outcomes Between Metabolic Syndrome (MetS) and Non-Metabolic Syndrome (non-MetS) Patients Event MetS (N=1,360) MetS (%) No MetS (N=101,000) Non-MetS (%) P-Value Odds Ratio CI (95%) Acute mesenteric ischemia 540 39.7% 38,110 37.7% 0.1361 1.0867 0.9741, 1.2123 chronic mesenteric ischemia 300 22.1% 22,540 22.3% 0.8204 0.9852 0.8659, 1.1208 Coronary artery disease 710 52.2% 40,170 39.8% < 0.0001 1.6541 1.4860, 1.8412 Peripheral arterial/vascular disease 960 70.6% 55,140 54.6% < 0.0001 1.9961 1.7752, 2.2445 Myocardial infarction 390 28.7% 22,220 22.0% < 0.0001 1.4255 1.2662, 1.6048 Stroke 490 36.0% 28,380 28.1% < 0.0001 1.4412 1.2891, 1.6113 Characteristics Female 910 66.9% 64,270 63.6% 0.0399 Male 450 33.1% 36,720 36.4% 0.1481 >65 880 64.7% 70,450 69.8% 0.0011 18-65 480 35.3% 21,150 20.9% < 0.0001 White 1,150 84.6% 81,580 80.8% 0.0011 AA 150 11.0% 10,580 10.5% 0.8428 Asian 20 1.5% 1,340 1.3% 0.9376 Multirace 20 1.5% 910 0.9% 0.7803 Unknown 210 15.4% 13,210 13.1% 0.3276 Other 50 3.7% 2,450 2.4% 0.5543 Refused 30 2.2% 1,590 1.6% 0.796 Hispanic/Latino N/A N/A 610 0.6% N/A asian/pacific islander N/A N/A 180 0.2% N/A native america/alaskan native N/A N/A 120 0.1% N/A Cardiomyopathy 220 16.2% 10,430 10.3% 0.0046 CHF 470 34.6% 27,770 27.5% 0.0006 COPD 530 39.0% 31,960 31.6% 0.0003 HTN 1,250 91.9% 76,780 76.0% < 0.0001 HLD 1,230 90.4% 65,310 64.7% < 0.0001 DM 910 66.9% 34,430 34.1% < 0.0001 CKD 600 44.1% 29,730 29.4% < 0.0001 ESRD 160 11.8% 7140 7.1% 0.023 Presence of cirrhosis 140 10.3% 5,100 5.0% 0.0051 Alcohol abuse 80 5.9% 5,860 5.8% 0.9697 tobacco abuse/smoking 1,180 86.8% 72,240 71.5% < 0.0001 Obesity 920 67.6% 23,330 23.1% < 0.0001

S926 Epidemiology of Interstitial Lung Disease in Patients With Inflammatory Bowel Disease – A Large Population-Based Study

Introduction: Interstitial lung disease (ILD) is a diverse spectrum of diseases resulting in scarring of lung parenchyma. Though considered rare, it is increasingly recognized in patients with inflammatory bowel disease (IBD). The pathogenesis is unclear but the changes in the lung are thought to represent the same type of inflammatory changes that occur in the bowel. The available literature on the association between IBD and ILD is largely based on case series. In this study, we sought to describe the epidemiology of ILD in patients with IBD. Methods: We queried a commercial database (Explorys Inc, Cleveland, OH), an aggregate of EHR data from 27 integrated healthcare systems in the United States between 3/2017-3/2022. We identified all patients in the database with CD or UC based on Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). We compared the prevalence of ILD at least 30 days post-CD or post-UC diagnosis to a control cohort of patients without CD or UC. Results: Of the 31,699,800 patients in the database, 145,290 patients had CD and 123,800 patients had UC. Overall prevalence of ILD was higher in CD (1.89%) and UC (1.91%) compared to non-IBD patients (0.8%), with odds ratio (OR) for CD 2.38 [95% CI, 2.29-2.47, p< 0.001], and UC 2.41 [95% CI, 2.31-2.51, p< 0.001]. Odds of ILD in IBD patients tended to be higher in the cohort aged 18-65 versus age > 65, in African Americans compared to Caucasians, and was otherwise similar across gender. Among autoimmune conditions associated with ILD, IBD patients with RA and SLE had a significantly lower prevalence of ILD compared to non-IBD patients with RA or SLE. IBD patients on treatment with sulfasalazine, azathioprine, infliximab, or adalimumab tended to have lower odds of developing ILD compared to non-IBD patients on the same medications. (Table) Conclusion: In this large population-based study, we found a significantly higher prevalence of ILD in patients with CD and UC compared to patients without IBD. Interestingly, IBD patients on treatment with any of the various anti-inflammatory agents, most of which are independently associated with ILD, had lower odds of developing ILD compared to non-IBD patients on the same drugs. This data suggests that anti-inflammatory medications and IBD may be independent risk factors for development of ILD. Thus, the mechanism of lung injury in IBD patients may be unique, in which case treatment with anti-inflammatory medications may serve as a protective factor. Table 1. - Prevalence of ILD after at least 30 days post-IBD diagnosis - Above is for Crohn's Disease (CD) and below is for Ulcerative Colitis (UC) X CD Prevalence per 100,000 No CD Prevalence per 100,000 Odds Ratio 95% CI P-Value TOTAL 2750 1892 253640 804 2.38 2.29-2.47 <0.001 Adult (18-65) 1250 1225 92020 497 2.48 2.35-2.63 <0.001 Senior (65+) 1480 3583 142000 1873 1.95 1.85-2.05 <0.001 Female 1610 1827 129250 746 2.48 2.36-2.6 <0.001 Male 1140 2014 124580 888 2.29 2.16-2.43 <0.001 Caucasian 2290 2098 181110 1085 1.95 1.88-2.04 <0.001 African American 310 2391 37420 1040 2.33 2.08-2.61 <0.001 Asian 30 1685 3430 690 2.47 1.72-3.55 <0.001 Amyloidosis 20 8696 1110 6442 1.38 0.87-2.2 0.17 Systemic Sclerosis 50 16290 3850 18527 0.85 0.62-1.15 0.281 Polymyositis 30 12000 2360 13003 0.91 0.62-1.34 0.64 Rheumatoid Arthritis 510 2802 18350 4779 0.57 0.53-0.63 <0.001 Systemic Lupus Erythematosus 260 2014 6360 5332 0.37 0.32-0.41 <0.001 x x x x x x x x X UC Prevalence per 100,000 No UC Prevalence per 100,000 Odds Ratio 95% CI P-Value TOTAL 2370 1914 254000 804 2.41 2.31-2.51 <0.001 Adult (18-65) 910 1155 92360 498 2.32 2.18-2.48 <0.001 Senior (65+) 1450 3260 142010 1874 1.78 1.69-1.87 <0.001 Female 1290 1740 129570 746 2.35 2.23-2.48 <0.001 Male 1080 2191 124610 888 2.5 2.35-2.66 <0.001 Caucasian 2020 2120 181370 1086 1.97 1.89-2.06 <0.001 African American 240 2556 37500 1041 2.49 2.19-2.83 <0.001 Asian 20 1163 3440 692 1.69 1.09-2.63 <0.02 Amyloidosis 20 10526 1100 6369 1.73 1.08-2.76 0.022 Systemic Sclerosis 30 11539 3870 18590 0.57 0.39-0.84 0.004 Polymyositis 30 13636 2360 12981 1.06 0.72-1.56 0.774 Rheumatoid Arthritis 320 2362 18520 4765 0.48 0.43-0.54 <0.001 Systemic Lupus Erythematosus 110 1175 6490 5283 0.21 0.18-0.26 <0.001

S1055 Crohn’s Disease Patients Treated With Anti-TNFs Have Lower Rates of Myocarditis

Introduction: Myocarditis is a rare extraintestinal cardiac manifestation of IBD. It is more commonly reported in Ulcerative Colitis than in Crohn's disease (CD) and consequently not frequently reported. Moreover, the prevalence of myocarditis in CD patients on immunosuppressive and immunomodulatory therapy is not well known. Our study aims to assess the prevalence of myocarditis and the effect of immune-modifying therapy in CD. Methods: In multi-institutional database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a concomitant diagnosis of myocarditis and CD between 1999 to 2022. We investigated the prevalence of myocarditis in CD compared to patients with no IBD. Also, we compared the prevalence between CD patients with and without immune-modifying agents. Results: Of the 70, 301,380 individuals in the database from 1999 to present, we identified 249,300 (0.3%) patients with CD, of whom 40,840 (16.4%) patients received anti-TNFs. CD patients were 59.4% females, 76% Caucasian, and 70% in 18-65 years age group. The prevalence of myocarditis was 0.12% for CD compared to 0.04% in individuals without IBD, p< 0.001. Compared to the general population, patients with CD had higher association risk of myocarditis diagnosis [OR: 3.33, p< 0.0001]. Among CD, predictors of having myocarditis included being elderly ( >65 y/o), African American, smokers and has history of type 2 diabetes (P< 0.0001). The prevalence of myocarditis was significantly lower CD patients on anti-TNF agents [OR: 0.08, p < 0.0001], and thiopurines [OR: 0.11, p < 0.0001] whereas methotrexate and 5-aminosalicylates (5-ASA) had higher rates [OR: 2.78, p < 0.0001] and [OR: 1.63, p =0.0001], respectively. No significant effect was noted with Vedolizumab [OR: 1.30, P= 0.4103] (Figure). Conclusion: In this large database, we found a higher risk association between CD and myocarditis. Anti-TNF agents and thiopurines were less likely to be associated with myocarditis, while methotrexate and 5-ASA were more likely to be associated with myocarditis in CD. The difference in the association between immune-modifying agents is unclear. Hence, further prospective studies are required to evaluate this association. Our findings may have significant implications for patients with cardiac risk factors and underlying myocardial dysfunction.Figure 1.: Overall Risk and Predictors of Myocarditis Among Crohn's disease. Univariate analysis used to calculate OR. OR; odds ratio, CI confidence interval. Anti-TNF; anti-tumor necrosis factor. 5-ASA; mesalamine.

S1252 Prevalence of Diagnosed Primary Biliary Cholangitis and Associated Conditions in the United States: Results From a National Electronic Patient Database

Introduction: Primary biliary Cholangitis (PBC) is an autoimmune disease that is associated with a number of autoimmune disorders. PBC is associated with liver and non-liver organ co-morbidities that contribute to clinical outcomes. Several studies have suggested an increase in the incidence and prevalence of PBC, although this has not been assessed in a large cohort and has not been consistent across all epidemiologic studies. We determined the nationwide prevalence of PBC and its association with other autoimmune and non-liver related conditions in the United States (US). Methods: A database (Explorys Inc, Cleveland, OH) of electronic health record data from 26 major integrated US healthcare systems was used. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), patients (age >18 years) with a diagnosis of PBC between 1999 to present were identified. Data were analyzed in patients with/without a diagnosis of PBC. The prevalence of associated diseases was compared in in the 2 groups, and statistical univariate binary logistic model was performed. Results: Of the 70,383,890 individuals in the database, we identified 11,070 cases of PBC, with a prevalence of 15.7/100,000 persons (0.02%). Prevalence was higher in females than males [odds ratio (OR) 32.84; 95% Confidence Interval (CI) 30.50-35.37, p < 0.0001], adults (≥ 65 years) versus adult (18-65 years) (OR) 2.18; 95% CI 2.07-2.30, p < 0.0001) and whites versus non-whites (OR 14.54; 95% CI 13.63-15.51, p < 0.0001) (Table). PBC patients were at higher odds (Table) of co-morbidities including ischemic heart disease, cerebrovascular accident, congestive heart failure and sarcopenia when compared to non-PBC patients (p < 0.0001). PBC patients were more likely than non-PBC patients to have primary sclerosing cholangitis ( OR 1061.43) autoimmune hepatitis (OR 537.93), Type 1 diabetes mellitus (OR 240.58), ulcerative colitis (OR 15.25), Crohn’s disease (OR 7.84), celiac disease (OR 8.99), autoimmune thyroiditis (OR 7.69), systemic lupus erythematosus (OR 14.66) and other autoimmune disorders (Figure). Conclusion: Our large nationwide analysis study demonstrates higher prevalence of PBC in the US than previously reported, which is likely a result of diagnosis at an early stage and prolonged survival that may be related to improved management. The high association between PBC and other autoimmune conditions suggest shared common pathogenesis of immune-mediated destruction of end organs in genetically susceptible individuals. Table 1. - Baseline Characteristic of Patients with Primary Biliary Cholangitis and Control Group PBC n=11,070 (%) No PBC n=70,372,820 (%) OR (95%CI) p-value Demographics Age 18-65 4,490(41%) 47,940,720(68%) 0.32(0.31-0.33) <0.0001 Age > 65 6,620(60%) 21,251,790(30%) 3.44(3.31-3.57) <0.0001 Male 1,610(15%) 31,420,380(45%) 0.21(0.20-0.22) <0.0001 Female 9,390(85%) 38,453,360(55%) 4.64(4.41-4.89) <0.0001 Caucasian 8,770(79%) 37,743,080(54%) 3.30(3.15-3.45) <0.0001 Comorbidities T2DM 2,810(25%) 5,650,420(8%) 3.90(3.73-4.07) <0.0001 HTN 1,950(18%) 3,493,560(5%) 4.09(3.89-4.29) <0.0001 HLD 5,940(54%) 11,779,380(17%) 5.76(5.55-5.98) <0.0001 Tobacco use 2,220(20%) 6,486,950(9%) 2.47(2.36-2.59) <0.0001 Hypothyroidism 3,300(30%) 4,049,030(6%) 6.96(6.68-7.25) <0.0001 Ischemic Heart Disease 1,240(11%) 2,496,690(4%) 3.43(3.23-3.64) <0.0001 CHF 1,070(10%) 1,834,510(3%) 4.00(3.75-4.26) <0.0001 Sarcopenia 4,910(44%) 5,480,850(8%) 9.44(9.09-9.80) <0.0001 Alcohol abuse 320(3%) 1,090,250(2%) 1.89(1.69-2.11) <0.0001 Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, T2DM;Type 2 Diabetes Miletus, HTN; Hypertension, HLD; Hyperlipidemia, CHF; Congestive Heart Failure. PBC; Primary Biliary Cholangitis. Figure 1.: Primary Biliary Cholangitis Associated Autoimmune Disorders. Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, PSC; Primary Sclerosing Cholangitis, AIH; Autoimmune Hepatitis, T1DM; Type 1 Diabetes Miletus, AIHA; Autoimmune Hemolytic Anemia, UC; Ulcerative Colitis, CD; Crohn's Disease, SLE; Systemic Lupus Erythematosus, ITP; Idiopathic Thrombocytopenia Purpura, AIT; Autoimmune Thyroiditis, RA; Rheumatoid Arthritis, MG; Myasthenia Gravis.

S1020 The Prevalence of Asthma Are Increased in Inflammatory Bowel Disease, but Decreased After Biologics Treatment: A Population-Based Study

Introduction: Inflammatory bowel disease (IBD) patients exhibit higher association with asthma. IBD and asthma are both immune-mediated disorders. Also, they share genetic and environmental factors. Previous studies suggested that initiation of biologics could achieve remission of asthma. However, data is limited in IBD. We sought to investigate the prevalence of asthma in IBD patients with and without biologics. Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) who were diagnosed with either CD or UC between 1999 and 2022 who were treated with any type of biologics. We investigated the prevalence of asthma in IBD patients compared to patients with no IBD. Also, we compared the prevalence between IBD patients with and without biologics therapy. Results: Of the 70,040,480 individuals in the database, we identified 249,480 (0.4%) patients with CD and 209,020 (0.3%) patients with UC, of whom 44,930 (18%) and 23,040 (11%) patients received biologics therapy, respectively. The prevalence of asthma was 21% for each CD and UC, compared to 7% in individuals without IBD, p< 0.0001 to all. The prevalence of asthma was significantly lower in biologics treated CD patients (16%) compared to those who did not receive biologics (22%) (Figure). Similarly, biologics treated UC patients were significantly less likely to have asthma (16%) compared to UC patients who did not receive biologics therapy (21%), p< 0.0001to all (Figure). Conclusion: This is the largest individual study investigating prevalence of asthma in patients with IBD with and without biologics therapy. We found that IBD patients who were treated with biologics were significantly less likely to have asthma when compared to IBD individuals who were never treated with biologics.Figure 1.: The Effect of Biologics in Patients with Asthma and Inflammatory Bowel Disease.

S933 Racial Disparities in Extraintestinal Manifestations in Patients With Inflammatory Bowel Disease

Introduction: Extraintestinal manifestations (EIM) are seen in 6% to 25% of IBD patients. While some EIMs occur as a direct result of bowel inflammation, other EIMs are due to an influx of mononuclear cells activated in the intestine but targeting extraintestinal organs. However, it is unclear if the pathogenesis and prevalence of EIM vary based on the race of IBD patients. Our study explored the prevalence of EIM of IBD among the major racial groups in the United States. Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of IBD between 1999 to 2022. Based on race, the study population was divided into two groups African American and Caucasian. The two groups were further categorized based on the extraintestinal manifestations of IBD. Results: Of the 70,383,890 individuals in the database, we identified 412,950 (0.59%) patients with IBD. Among all IBD patients, 32,870 were African American (8%) and 314,660 (76.2%) were Caucasian. When compared with Caucasians, African American IBD patients were at increased risk of pyoderma gangrenosum (OR 1.61), erythema nodosum (OR 1.39), pulmonary embolism (PE) (OR 1.06), deep vein thrombosis (DVT) (OR 1.24), interstitial lung disease (ILD) (OR 1.14), chronic kidney disease (CKD) (OR1.43), uveitis (OR 2.65), episcleritis (OR 1.78) and autoimmune hepatitis (AIH) (OR 1.54) . However, psoriasis (OR 0.49), vasculitis (OR 0.87) , ankylosing spondylitis (OR 0.82) and osteoporosis (OR 0.63) were less common in African American IBD patients (Table). Conclusion: Our large cohort of IBD patients demonstrates significant racial differences in the prevalence of EIM of IBD in the United States. The association between race and extraintestinal inflammation in IBD patients is unclear. Further research into racial variations in the pathophysiology of EIM in IBD patients is required. Table 1. - Comparison of The Prevalence of Extra-Intestinal Manifestations Among Caucasian and African-American IBD Patients AA IBD n=32,870 (%) Caucasian IBD n=314,660 (%) OR CI P-value Pyoderma Gangrenosum 210 (0.6%) 1,250 (0.4%) 1.61 1.61-1.87 < 0.0001 Erythema nodosum 180 (0.5%) 1,240 (0.4%) 1.39 1.19-1.63 < 0.0001 AIH 140 (0.4%) 870 (0.3%) 1.54 1.29-1.84 < 0.0001 ILD 1,080 (3.3%) 9,070 (2.9%) 1.14 1.07-1.22 < 0.0001 Episcleritis 80 (0.2%) 430 (0.1%) 1.78 1.40-2.26 < 0.0001 Uveitis 740 (2.3%) 2,710 (0.9%) 2.65 2.44-2.88 < 0.0001 PE 1,650 (5%) 14,930 (4.7%) 1.06 1.01-1.11 =0.0261 DVT 1,860 (5.7%) 14,500 (4.6%) 1.24 1.18-1.31 < 0.0001 CKD 4,740 (14.4%) 33,250 (10.6%) 1.43 1.38-1.47 < 0.0001 Psoriasis 440 (1.3%) 8,540 (2.7%) 0.49 0.44-0.54 < 0.0001 Vasculitis 1,930 (5.9%) 21,130 (6.7%) 0.87 0.83-0.91 < 0.0001 Ankylosing Spondylitis 250 (0.8%) 2,910 (0.9%) 0.82 0.72-0.93 = 0.0029 Osteoporosis 2,590 (7.9%) 37,680 (12%) 0.63 0.60-0.66 < 0.0001 Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, AA; African-American, IBD; inflammatory bowel disease, AIH;Autoimmune hepatitis, ILD; interstitial lung disease, PE; pulmonary embolism, DVT; deep venous thrombosis, CKD; chronic kidney disease.

A taxonomy for community pharmacy patient care services reported in Pharmacist eCare Plans

BackgroundPharmacies belonging to the Community Pharmacy Enhanced Service Networks (CPESN) are transforming their practices with support of the Flip the Pharmacy initiative. These pharmacies are submitting eCare plans that describe care that they have provided to patients. ObjectivesThe objectives of this study were (1) To develop a taxonomy for services reported by community pharmacies participating in year 1 of the Flip the Pharmacy initiative and (2) to illustrate the use of the taxonomy for hypertension-related services. MethodsA retrospective observational study design was used. The analyzed data were extracted from eCare plans submitted by participating pharmacies during the first year of the Flip the Pharmacy initiative (October 1, 2019-September 30, 2020). Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) codes submitted for encounter reason and for procedures were sorted into categories based on similarity of terminology in the SNOMED-CT code labels. All SNOMED-CT codes in the encounter reasons that had blood pressure or hypertension in their labels were mapped to taxonomy categories. Descriptive statistics were calculated for all variables. ResultsA total of 368,297 eCare plans reporting 1,049,061 SNOMED-CT procedures were submitted for 133,210 patients by 526 pharmacies. Seven categories of community pharmacy patient care services were identified: medication synchronization, medication review, monitoring, immunizations, patient education, adherence, and recommendations. Over half of the encounter reasons (63.5%) and procedures (56.2%) were for medication synchronization. Both medication review and monitoring accounted for about 10% of the encounters, and medication review made up over 30% of procedures. A total of 18,307 encounters were related to hypertension. Of these, monitoring was the most frequent, with 11,285 encounters (61.6%) encounters, followed by patient education, with 5173 encounters (28.3%). ConclusionCPESN pharmacies are delivering a wide range of patient care services. This taxonomy provides a concise way to organize and report services being delivered by community pharmacies.

Proton Pump Inhibitors Use and Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Retrospective Cohort Analysis.

BackgroundSince their introduction in the early 1980s, proton pump inhibitors (PPIs) have been used worldwide for a broad range of indications. Unfortunately, however, PPIs have become overly prescribed by healthcare providers, sometimes in the absence of clear indications. Although PPIs were initially presumed to have an excellent safety profile, emerging studies have shed light on the association between their long-term use and a myriad of side effects, including the possibility of an increased risk of spontaneous bacterial peritonitis (SBP). Data available to date regarding the association between PPI use and SBP development in cirrhotic patients is conflicting. While some observational studies provide no association between PPI use in cirrhotic patients and an increased risk of SBP development, many others support this association. As a result of the conflicting conclusions from case controls, cohorts, and meta-analyses, we aimed to carry out this retrospective cohort analysis of data from cirrhotic patients included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Our aim was to evaluate for a possible association between PPIs use and the risk of SBP development in cirrhotic patients and to compare the prevalence of SBP development between cirrhotic patients who were actively using PPIs and those who were not.MethodsA retrospective cohort analysis with chart review was conducted on patients with cirrhosis who were included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Using this database, records were reviewed between December 2017 and 2020. Included patients were adults aged 30 to 79 years with a Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of liver cirrhosis. Included patients with a SNOMED-CT diagnosis of liver cirrhosis were divided into two groups: the first group included all cirrhotic patients who did not use PPIs and the second group included all cirrhotic patients who were on PPIs at home.ResultsIn our analysis, SBP occurred in 1.7% (1,860 patients) of the included cirrhotic patients whether they were actively taking PPIs or not. Among the 40,670 cirrhotic patients who were on PPIs at home, 1,350 (3.3%) patients developed SBP. On multivariate analysis, PPI use was the strongest predictor for SBP in cirrhotic patients (odds ratio (OR) = 4.24; 95% confidence interval (CI): 3.83 - 4.7, P value < 0.0001), with cirrhotic patients taking PPIs being 4.24 more likely to develop SBP than those not on PPIs. In addition, PPI use, history of bleeding varices, age, race, and gender were found to be independent predicting factors for SBP, in descending order of importance.ConclusionsOur retrospective cohort analysis has shown that the use of PPIs in patients with liver cirrhosis is an independent predicting risk factor for SBP development. It solidified the argument that cirrhotic patients receiving this form of therapy seem to have a higher risk of developing SBP. In the setting of the emerging evidence that PPIs might impose health risks in cirrhotic patients, further studies are needed to settle the current debate between supporters and opponents of this proposition. In addition, future studies may help clarify the relationship between the occurrence of SBP in cirrhotic patients and the type, dose, and duration of PPIs used. We recommend that unless it is clearly indicated, PPI therapy should be avoided or administered with caution in patients with cirrhosis.

Mapping Korean National Health Insurance Reimbursement Claim Codes for Therapeutic and Surgical Procedures to SNOMED-CT to Facilitate Data Reuse.

South Korea has a public and single-payer system for healthcare services based on fee-for-service payments. The National Health Insurance (NHI) reimbursement claim codes are used by all healthcare providers for reimbursement. This study mapped NHI reimbursement claim codes for therapeutic and surgical procedures to the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate semantic interoperability and data reuse for research. The Source codes for mapping were 2,500 reimbursement claim codes for therapeutic and surgical procedures such as surgery, endoscopic procedures, and interventional radiology. The target terminology for mapping was the 'Procedure' hierarchy of the international edition of SNOMED-CT released in July 2019. We translated Korean terms into English, clarified their meaning, extracted characteristics of the source codes, and mapped them to pre-coordinated concepts. If a source concept was not mapped to a pre-coordinated concept, we mapped it to a post-coordinated expression. The mapping results were validated internally using dual independent mapping and group discussion by trained terminologists, and by two physicians with experience of SNOMED-CT mapping. Out of 2,500 source codes, 1,298 (51.9%) codes were mapped to pre-coordinated concepts, and 1,202 (48.1%) codes were mapped to post-coordinated expressions. The mapping of the NHI reimbursement claim codes for therapeutic and surgical procedures to SNOMED-CT is expected to support clinical research by facilitating the utilization of health insurance claim data.