Administrative codes may have limited utility in diagnosing biliary colic in emergency department visits: A validation study

Jordan Nantais,Muhammad Mansour,Charles de Mestral,Shiva Jayaraman,David Gomez Korean Association of Hepato-Biliary-Pancreatic Su 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.3

Backgrounds/Aims: Biliary colic is a common cause of emergency department (ED) visits; however, the natural history of the disease and thus the indications for urgent or scheduled surgery remain unclear. Limitations of previous attempts to elucidate this natural history at a population level are based on the reliance on the identification of biliary colic via administrative codes in isolation. The purpose of our study was to validate the use of International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision, Canadian modification (ICD-10-CA) from ED visits in adequately differentiating patients with biliary colic from those with other biliary diagnoses such as cholecystitis or common bile duct stones. Methods: We performed a retrospective validation study using administrative data from two large academic hospitals in Toronto. We assessed all the patients presenting to the ED between January 1, 2012 and December 31, 2018, assigned ICD-10-CA codes in keeping with uncomplicated biliary colic. The codes were compared to the individually abstracted charts to assess diagnostic agreement. Results: Among the 991 patient charts abstracted, 26.5% were misclassified, corresponding to a positive predictive value of 73% (95% confidence interval 73%–74%). The most frequent reasons for inaccurate diagnoses were a lack of gallstones (49.8%) and acute cholecystitis (27.8%). Conclusions: Our findings suggest that the use of ICD-10 codes as the sole means of identifying biliary colic to the exclusion of other biliary pathologies is prone to moderate inaccuracy. Previous investigations of biliary colic utilizing administrative codes for diagnosis may therefore be prone to unforeseen bias.

Cutaneous Patches to Monitor Myoelectric Activity of the Gastrointestinal Tract in Postoperative Pediatric Patients

Jordan S. Taylor,Vivian de Ruijter,Ryan Brewster,Anand Navalgund,Lindsay Axelrod,Steve Axelrod,James C.Y. Dunn,James K. Wall 대한소아소화기영양학회 2019 Pediatric gastroenterology, hepatology & nutrition Vol.22 No.6

Purpose: Limited means exist to assess gastrointestinal activity in pediatric patients postoperatively. Recently, myoelectric gastrointestinal activity recorded by cutaneous patches has been shown in adult patients to be predictive of clinical return of gastrointestinal function postoperatively. The aim of this case series is to demonstrate the feasibility of this system in pediatric patients and to correlate myoelectric signals with return of bowel function clinically. Methods: Pediatric patients undergoing abdominal surgery were recruited to have wireless patches placed on the abdomen within two hours postoperatively. Myoelectric data were transmitted wirelessly to a mobile device with a user-interface and forwarded to a cloud server where processing algorithms identified episodes of motor activity, quantified their parameters and nominally assigned them to specific gastrointestinal organs based on their frequencies. Results: Three patients (ages 5 months, 4 year, 16 year) were recruited for this study. Multiple patches were placed on the older subjects, while the youngest had a single patch due to space limitations. Rhythmic signals of the stomach, small intestine, and colon could be identified in all three subjects. Patients showed gradual increase in myoelectric intestinal and colonic activity leading up to the first recorded bowel movement. Conclusion: Measuring myoelectric intestinal activity continuously using a wireless patch system is feasible in a wide age range of pediatric patients. The increase in activity over time correlated well with the patients' return of bowel function. More studies are planned to determine if this technology can predict return of bowel function or differentiate between physiologic ileus and pathologic conditions.

Relationship between Age and Oxygen along Line W in the Northwest Atlantic Ocean

Jordan L. Thomas,Darryn W. Waugh,Anand Gnanadesikan 한국해양과학기술원 2020 Ocean science journal Vol.55 No.2

The relationship between age and oxygen is one that is often assumed in oceanography to be relatively simple. Because oxygen utilization rates are difficult to directly measure in the ocean, it is commonly assumed that the apparent oxygen utilization divided by the water age is a good representation of respiration. Likewise, because of limited transient tracer observations and difficulties constraining water age, it has been suggested that oxygen could be a useful proxy for age. In this paper, we explore the relationship between age and oxygen using observations from Line W, a repeat hydrography cruise track which crosses the Gulf Stream, extending from Cape Cod to Bermuda, and an Earth System Model simulation. In both the observations and the model, the assumed positive linear relationship between apparent oxygen utilization (AOU) and mean age is not found within and directly below the ventilated thermocline at the end of Line W. In the Earth System Model decoupling of age and AOU is found in gyre centers, in some coastal upwelling zones, and downstream of mode water formation regions that show large variability in isopycnal depth. In all three regions, differences in the spatial distribution of sources of age and AOU become critically important, producing offset maxima in the gyre centers, and different time variability of sources in the other two areas.

No causal effects of serum urate levels on the risk of chronic kidney disease: A Mendelian randomization study

Jordan, Daniel M.,Choi, Hyon K.,Verbanck, Marie,Topless, Ruth,Won, Hong-Hee,Nadkarni, Girish,Merriman, Tony R.,Do, Ron Public Library of Science 2019 PLoS medicine Vol.16 No.1

<▼1><P><B>Background</B></P><P>Studies have shown strong positive associations between serum urate (SU) levels and chronic kidney disease (CKD) risk; however, whether the relation is causal remains uncertain. We evaluate whether genetic data are consistent with a causal impact of SU level on the risk of CKD and estimated glomerular filtration rate (eGFR).</P><P><B>Methods and findings</B></P><P>We used Mendelian randomization (MR) methods to evaluate the presence of a causal effect. We used aggregated genome-wide association data (<I>N</I> = 110,347 for SU, <I>N</I> = 69,374 for gout, <I>N</I> = 133,413 for eGFR, <I>N</I> = 117,165 for CKD), electronic-medical-record-linked UK Biobank data (<I>N</I> = 335,212), and population-based cohorts (<I>N</I> = 13,425), all in individuals of European ancestry, for SU levels and CKD. Our MR analysis showed that SU has a causal effect on neither eGFR level nor CKD risk across all MR analyses (all <I>P</I> > 0.05). These null associations contrasted with our epidemiological association findings from the 4 population-based cohorts (change in eGFR level per 1-mg/dl [59.48 μmol/l] increase in SU: −1.99 ml/min/1.73 m<SUP>2</SUP>; 95% CI −2.86 to −1.11; <I>P</I> = 8.08 × 10<SUP>−6</SUP>; odds ratio [OR] for CKD: 1.48; 95% CI 1.32 to 1.65; <I>P</I> = 1.52 × 10<SUP>−11</SUP>). In contrast, the same MR approaches showed that SU has a causal effect on the risk of gout (OR estimates ranging from 3.41 to 6.04 per 1-mg/dl increase in SU, all <I>P</I> < 10<SUP>−3</SUP>), which served as a positive control of our approach. Overall, our MR analysis had >99% power to detect a causal effect of SU level on the risk of CKD of the same magnitude as the observed epidemiological association between SU and CKD. Limitations of this study include the lifelong effect of a genetic perturbation not being the same as an acute perturbation, the inability to study non-European populations, and some sample overlap between the datasets used in the study.</P><P><B>Conclusions</B></P><P>Evidence from our series of causal inference approaches using genetics does not support a causal effect of SU level on eGFR level or CKD risk. Reducing SU levels is unlikely to reduce the risk of CKD development.</P></▼1><▼2><P><B>Author summary</B></P><P><B>Why was this study done?</B></P><P>Epidemiological studies have shown strong correlations between serum urate (SU) levels and chronic kidney disease (CKD) risk.</P><P>Elevated SU levels are often found in patients with CKD, but it is not clear whether high serum urate is a cause of kidney disease or just a common co-occurrence.</P><P>Previous studies examining whether SU levels had a causal effect on CKD were limited due to not having large enough samples to detect a true causal relationship if it existed and/or had limitations related to the methodology.</P><P>Several clinical trials have been started that aim to use urate-lowering medication to prevent CKD.</P><P><B>What did the authors do and find?</B></P><P>To determine whether SU level has a causal effect on CKD, we used a methodology known as Mendelian randomization to test whether genetic variants known to increase SU level also increased the risk of CKD.</P><P>We used multiple datasets to perform Mendelian randomization analyses, which included meta-analyses performed across multiple population-based cohorts, 4 individual population-based cohorts, and the large electronic-medical-record-linked UK Biobank.</P><P>Across all datasets, we found no significant causal connection between SU level and risk of CKD.</P><P><B>What do these findings mean?</B></P><P>Our findings do not support a causal role of SU level in CKD.</P><P>Lower SU levels would be unlikely to translate into reduced risk of CKD.</P></▼2>

Are coach education programmes the most effective method for coach development?

Jordan Maclean,Ross Lorimer 한국코칭능력개발원 2016 International Journal of Coaching Science Vol.10 No.2

The purpose of this study is to establish whether coaches from a multi-sport context develop most effectively through coach education programmes and whether formal learning is fostering coach effectiveness. A sample of eight qualified male multi-sports’ coaches participated with an age range of 24 to 52 years (M = 32.6, ± = 8.9) and 9 to 18 years coaching experience (M = 12.6, ± = 3.8). Qualitative semi structured interviews were employed, lasting approximately 30 to 60 minutes. The data then underwent a thematic analysis process reducing the data into six overarching themes: values of the coach; the coach’s role on athlete development; forms of learning; barriers regarding coach education; role of governing bodies; coaches career pathway. The findings of the study indicated coaches access a wide range of sources to enhance their practice, but informal learning was preferred (interacting with other coaches and learning by doing). This resulted from numerous barriers experienced surrounding the delivery, cost and access to coach education programmes preventing coaches from progressing through the pathway. However, coaches in the study feel coach education should be a mandatory process for every coach. The findings have implications for policymakers and sport organisations in developing their coach education structure.

Narrative Review of Perioperative Acupuncture for Clinicians

Jordan A. Gliedt,Clinton J. Daniels,Adam Wuollet 사단법인약침학회 2015 Journal of Acupuncture & Meridian Studies Vol.8 No.5

Acupuncture is one of the oldest forms of the natural healing arts. The exact mechanisms of action are unknown at this time; however, current theories to explain the benefits experienced after acupuncture include Traditional Chinese Medicine and Western medicine concepts. Acupuncture may improve the quality of perioperative care and reduce associated complications. Perioperative acupuncture is apparently effective in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain. The Pericardium-6 (P-6; Nei Guan), Yintang (Extra 1), and Shenmen acupuncture points are the most studied and effective acupuncture points in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain experiences. Intraoperatively administered acupuncture may reduce immunosuppression in patients and lessen intraoperative anesthetic requirements, although the clinical usefulness of acupuncture in the intraoperative period remains inconclusive. Perioperative acupuncture is a promising intervention, but additional studies are needed to further understand and define acupuncture's role throughout the perioperative period and determine its clinical usefulness. The purpose of this article is to provide a brief clinical review concerning acupuncture and its application for common issues that occur in the perioperative period.

Poisson spectra in polynomial algebras

Jordan, D.A.,Oh, S.Q. Academic Press 2014 Journal of algebra Vol.400 No.-

A significant class of Poisson brackets on the polynomial algebra C[x<SUB>1</SUB>,...,x<SUB>n</SUB>] is studied and, for this class of Poisson brackets, the Poisson prime ideals, Poisson primitive ideals and symplectic cores are determined. Moreover it is established that these Poisson algebras satisfy the Poisson Dixmier-Moeglin equivalence.

Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano

Jordan Au,Francis M. Hulme-Moir,Andrew Herd,Mathew A. Kozman 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.S

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

Erratum to "Obesity as a Possible Risk Factor For Lost-Time Injury In Registered Nurses: A Literature Review" [Saf Health Work 6 (1) (2015) 1-8]

Jordan, Gillian,Nowrouzi-Kia, Behnam,Gohar, Basem,Nowrouzi, Behdin Occupational Safety and Health Research Institute 2015 Safety and health at work Vol.6 No.2

Intraductal Carcinoma of Prostate: A Comprehensive and Concise Review

Jordan A. Roberts,노재윤,Ming Zhou,박용욱 대한병리학회 2013 Journal of Pathology and Translational Medicine Vol.47 No.5

Intraductal carcinoma of the prostate (IDC-P) is defined as a proliferation of prostate adenocarcinoma cells distending and spanning the lumen of pre-existing benign prostatic ducts and acini, with at least focal preservation of basal cells. Studies demonstrate that IDC-P is strongly associated with high-grade (Gleason grades 4/5), large-volume invasive prostate cancers. In addition, recent genetic studies indicate that IDC-P represents intraductal spread of invasive carcinoma, rather than a precursor lesion. Some of the architectural patterns in IDC-P exhibit architectural overlap with one of the main differential diagnoses, high-grade prostatic intraepithelial neoplasia (HGPIN). In these instances, additional diagnostic criteria for IDC-P, including marked nuclear pleomorphism, non-focal comedonecrosis (>1 duct showing comedonecrosis), markedly distended normal ducts/acini, positive nuclear staining for ERG, and cytoplasmic loss of PTEN by immunohistochemistry, can help make the distinction. This distinction between IDC-P and HGPIN is of critical importance because IDC-P has an almost constant association with invasive carcinoma and has negative clinical implications, including shorter relapse-free survival, early biochemical relapse, and metastatic failure rate after radiotherapy. Therefore, IDC-P should be reported in prostate biopsies and radical prostatectomies, regardless of the presence of an invasive component. This article will review the history, diagnostic criteria, molecular genetics, and clinical significance of IDC-P.