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Association Between Hyperoxemia and Increased Cell-Free Plasma Hemoglobin During Cardiopulmonary Bypass in Infants and Children.

Pediatr Crit Care Med 2021 Sep 24. Epub 2021 Sep 24.

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. Department of Pediatrics, Division of Critical Care Medicine, Ochsner Hospital for Children, New Orleans, LA. Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA. Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA. UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.

Objectives: To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis.

Design: Prospective observational study.

Setting: Cardiac ICU in a university-affiliated children's hospital. Read More

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September 2021

Prediction Model Performance With Different Imputation Strategies: A Simulation Study Using a North American ICU Registry.

Pediatr Crit Care Med 2021 Sep 24. Epub 2021 Sep 24.

Department of Statistics, University of British Columbia, Vancouver, BC, Canada. Research Institute, BC Children's Hospital, Vancouver, BC, Canada. Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada. Department of Pediatrics, Division of Critical Care, University of British Columbia, Vancouver, BC, Canada.

Objectives: To evaluate the performance of pragmatic imputation approaches when estimating model coefficients using datasets with varying degrees of data missingness.

Design: Performance in predicting observed mortality in a registry dataset was evaluated using simulations of two simple logistic regression models with age-specific criteria for abnormal vital signs (mentation, systolic blood pressure, respiratory rate, WBC count, heart rate, and temperature). Starting with a dataset with complete information, increasing degrees of biased missingness of WBC and mentation were introduced, depending on the values of temperature and systolic blood pressure, respectively. Read More

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September 2021

Association Between Anticholinergic Drug Burden and Adequacy of Enteral Nutrition in Critically Ill, Mechanically Ventilated Pediatric Patients.

Pediatr Crit Care Med 2021 Sep 27. Epub 2021 Sep 27.

Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA. Harvard Medical School, Boston, MA. Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China. Center for Nutrition, Boston Children's Hospital, Boston, MA.

Objectives: Enteral nutrition delivery is limited by intolerance and interruptions in critically ill children. Anticholinergic properties of frequently administered medications may contribute to altered gastric motility and enteral nutrition intolerance in this population. We examined the association between the anticholinergic burden of administered medications using the Anticholinergic Drug Scale and adequacy of enteral nutrition delivery. Read More

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September 2021

Antimicrobial Stewardship in Bronchiolitis: A Retrospective Cohort Study of Three PICUs in Canada.

Pediatr Crit Care Med 2021 Sep 27. Epub 2021 Sep 27.

Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, Riyadh, Saudi Arabia. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. Division of Pediatric Critical Care, Department of Pediatrics, University of Toronto, Toronto, ON, Canada. Department of Pathology and Lab Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada. Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada. Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, QC, Canada. Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. Division of Pediatric Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. Research Institute of the McGill University Health Centre, Montreal, QC, Canada. Division of Pediatric Critical Care, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Montreal, QC, Canada.

Objectives: To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis.

Design: A multicenter retrospective cohort study.

Setting: Three Canadian PICUs over two winter seasons. Read More

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September 2021

Pediatric Sepsis Biomarker Risk Model Biomarkers and Estimation of Myocardial Dysfunction in Pediatric Septic Shock.

Pediatr Crit Care Med 2021 Sep 27. Epub 2021 Sep 27.

Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Objectives: Sepsis-associated myocardial dysfunction is common in pediatric septic shock and negatively impacts outcomes. Early estimation of sepsis-associated myocardial dysfunction risk has the potential to inform clinical care and improve clinical trial design. The Pediatric Sepsis Biomarker Risk Model II is validated as a biomarker-based enrichment algorithm to discriminate children with septic shock with high baseline mortality probability. Read More

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September 2021

Intra-operative ventilator mechanical power as a predictor of postoperative pulmonary complications in surgical patients: A secondary analysis of a randomised clinical trial.

Eur J Anaesthesiol 2021 Sep 22. Epub 2021 Sep 22.

From the Department of Anaesthesia (DK, LW, PP, LE, RH, BP, COT, DS, MOD, PH, CO, JG), Department of Intensive Care, Austin Hospital (DK, ASN, AW, GE, RB, DAJ), Department of Critical Care (DK, ASN, PP, LE, RH, BP, COT, DS, RB), Department of Surgery, University of Melbourne (LW, LE, RH, BP, COT), Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (ASN, RB, DAJ), Data Analytics Research and Evaluation (DARE) Centre, University of Melbourne, Melbourne, Victoria, Australia (ASN, RB) and Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil (ASN).

Background: Studies in critically ill patients suggest a relationship between mechanical power (an index of the energy delivered by the ventilator, which includes driving pressure, respiratory rate, tidal volume and inspiratory pressure) and complications.

Objective: We aimed to assess the association between intra-operative mechanical power and postoperative pulmonary complications (PPCs).

Design: Post hoc analysis of a large randomised clinical trial. Read More

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September 2021

Dose to neuroanatomical structures surrounding pituitary adenomas and the effect of stereotactic radiosurgery on neuroendocrine function: an international multicenter study.

J Neurosurg 2021 Sep 24:1-9. Epub 2021 Sep 24.

20Centro Gamma Knife Dominicano and Radiology Department, CEDIMAT, Santo Domingo, Dominican Republic.

Objective: Stereotactic radiosurgery (SRS) provides a safe and effective therapeutic modality for patients with pituitary adenomas. The mechanism of delayed endocrine deficits based on targeted radiation to the hypothalamic-pituitary axis remains unclear. Radiation to normal neuroendocrine structures likely plays a role in delayed hypopituitarism after SRS. Read More

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September 2021

Artificial intelligence for quality control of oscillometry measures.

Comput Biol Med 2021 Sep 14;138:104871. Epub 2021 Sep 14.

Department of Electronic, Information and Bioengineering, Politecnico di Milano University, Milan, Italy.

Background: The forced oscillation technique (FOT) allows non-invasive lung function testing during quiet breathing even without expert guidance. However, it still relies on an operator for excluding breaths with artefacts such as swallowing, glottis closure and coughing. This manual selection is operator-dependent and time-consuming. Read More

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September 2021

High intelligence may exacerbate paediatric inflammatory response to SARS-CoV-2 infection.

Med Hypotheses 2021 Sep 9;155:110677. Epub 2021 Sep 9.

Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

The body's innate and acquiredimmunesystems are critical in responses to a wide spectrum of assaults, including SARS-CoV-2 infection. We identify studies of autoimmunity to support our hypothesis that a high intelligence quotient (IQ) may put children at increased risk for severe COVID-19 sequelae; especially those whose viral load is high and/or who develop multisystem inflammatory syndrome in children (MIS-C). MIS-C is associated with a higher risk of COVID-19 morbidity and death, even in otherwise healthy children. Read More

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September 2021

Circadian variation in new-onset atrial fibrillation in patients in ICUs.

J Crit Care 2021 Sep 21;67:1-2. Epub 2021 Sep 21.

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; National Institute for Health Research Biomedical Research Centre, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address:

New-onset atrial fibrillation (NOAF) is common in patients treated on an intensive care unit (ICU). Onset of certain arrhythmias exhibit circadian variation. Whether NOAF follows a circadian rhythm in patients in ICU is unknown. Read More

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September 2021

Comparing the diagnostic accuracy of rapid antigen detection tests to real time polymerase chain reaction in the diagnosis of SARS-CoV-2 infection: A systematic review and meta-analysis.

J Clin Virol 2021 Sep 16;144:104985. Epub 2021 Sep 16.

Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

Background: Timely and accurate diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is crucial to reduce the risk of viral transmission. We investigated the diagnostic accuracy of rapid antigen detection tests (RADTs) in the diagnosis of SARS-CoV-2 infection.

Methods: A systematic literature search was performed using Pubmed, Embase, and the Cochrane Central Register. Read More

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September 2021

Accuracy of Infrared Thermography in Detecting Febrile Critically Ill Patients.

Anaesth Crit Care Pain Med 2021 Sep 21:100951. Epub 2021 Sep 21.

Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt. Electronic address:

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September 2021

An Assessment of Global Neurotrauma Prevention and Care Delivery: The Provider Perspective.

World Neurosurg 2021 Sep 21. Epub 2021 Sep 21.

Program in Global Surgery and Social Change, Harvard University, Boston, MA, USA.

Introduction: Neurotrauma is one of the leading causes of morbidity and mortality around the world. Assessment of injury prevention and pre-hospital care for neurotrauma patients is necessary to improve care systems.

Methods: A 29-question electronic survey was developed based on the EQUATOR checklist to assess neurotrauma policies and laws related to safety precautions. Read More

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September 2021

Magnetic Twitch Assessment of Diaphragm and Quadriceps Weakness in Critically Ill Mechanically Ventilated Patients.

Respir Physiol Neurobiol 2021 Sep 21:103789. Epub 2021 Sep 21.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY, United States. Electronic address:

Critically ill mechanically ventilated (MV) patients develop significant muscle weakness, which has major clinical consequences. There remains uncertainty, however, regarding the severity of leg weakness, the precise relationship between muscle strength and thickness, and the risk factors for weakness in MV patients. We therefore measured both diaphragm (PdiTw) and quadriceps (QuadTw) strength in MV patients using magnetic stimulation and compared strength to muscle thickness. Read More

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September 2021

Query bot for retrieving patients' clinical history: a COVID-19 use-case.

J Biomed Inform 2021 Sep 21:103918. Epub 2021 Sep 21.

Department of Radiology, Mayo Clinic, Arizona, AZ, USA 85054; School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, AZ USA 85281.

Objective: With increasing patient complexity whose data are stored in fragmented health information systems, automated and time-efficient ways of gathering important information from the patients' medical history are needed for effective clinical decision making. Using COVID-19 as a case study, we developed a query-bot information retrieval system with user-feedback to allow clinicians to ask natural questions to retrieve data from patient notes.

Materials And Methods: We applied clinicalBERT, a pre-trained contextual language model, to our dataset of patient notes to obtain sentence embeddings, using K-Means to reduce computation time for real-time interaction. Read More

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September 2021

Catheter Lock Solutions for Reducing Catheter-Related Bloodstream Infections in Pediatric Patients: a network meta-analysis.

J Hosp Infect 2021 Sep 21. Epub 2021 Sep 21.

Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Electronic address:

Background: Different catheter lock solutions (CLSs) are used to reduce catheter-related bloodstream infection (CRBSI) for pediatric patients with central venous catheters (CVCs). But the most effective CLS is unknown.

Aim: To compare the effectiveness of different CLSs for the prevention of CRBSI in pediatric patients. Read More

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September 2021

Role of melatonin in attenuation of hemodynamic response to intubation and anesthetic requirements: a randomized controlled double blind study.

Braz J Anesthesiol 2021 Sep 21. Epub 2021 Sep 21.

Dr. S.N. Medical College, Department of Orthopedics, Jodhpur, India.

Background: Melatonin has been studied to have anxiolytic, sedative, and analgesic effects. However, there is limited data on the effect of melatonin in the attenuation of hemodynamic response to intubation. We aimed to study whether preanesthetic oral melatonin attenuates hemodynamic responses to intubation and anesthetic requirements. Read More

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September 2021

IL-33 Signaling in Sensory Neurons Promotes Dry Skin Itch.

J Allergy Clin Immunol 2021 Sep 21. Epub 2021 Sep 21.

Center for the Study of Itch & Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address:

Background: Chronic pruritus, or itch, is common and debilitating, but the neuro-immune mechanisms that drive chronic itch are only starting to be elucidated. Recent studies demonstrate that the IL-33 receptor (IL-33R) is expressed by sensory neurons. However, whether sensory neuron-restricted activity of IL-33 is necessary for chronic itch remains poorly understood. Read More

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September 2021

Analytical and clinical performance of cPass neutralizing antibodies assay.

Clin Biochem 2021 Sep 21. Epub 2021 Sep 21.

Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, 77030, United States; Section of Clinical Chemistry, Division of Laboratory Medicine, Department of Pathology, Texas Children's Hospital, Houston, TX, 77030, United States. Electronic address:

Serological tests for SARS-CoV-2 are a critical component of disease control strategies. SARS-CoV-2 serology tests used in clinical diagnostic should not accurately evaluate total levels the antibodies but also closely correlate with neutralizing antibodies titers. However, only limited data is available reporting correlation of neutralization antibody assays with commercial high-throughput serological assays widely used in clinical laboratories. Read More

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September 2021

PKCλ/ι inhibition activates an ULK2-mediated interferon response to repress tumorigenesis.

Mol Cell 2021 Sep 18. Epub 2021 Sep 18.

Department of Pathology and Laboratory Medicine and Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA. Electronic address:

The interferon (IFN) pathway is critical for cytotoxic T cell activation, which is central to tumor immunosurveillance and successful immunotherapy. We demonstrate here that PKCλ/ι inactivation results in the hyper-stimulation of the IFN cascade and the enhanced recruitment of CD8 T cells that impaired the growth of intestinal tumors. PKCλ/ι directly phosphorylates and represses the activity of ULK2, promoting its degradation through an endosomal microautophagy-driven ubiquitin-dependent mechanism. Read More

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September 2021

IL-27 mediates anti-inflammatory effect in cigarette smoke induced emphysema by negatively regulating IFN-γ producing cytotoxic CD8 T cells in mice.

Eur J Immunol 2021 Sep 24. Epub 2021 Sep 24.

Department of Respiratory and Critical Care Medicine, Wuming Hospital of Guangxi Medical University.

Chronic airway inflammation mediated by CD8 T lymphocytes contributes to the pathogenesis of Chronic obstructive pulmonary disease(COPD). Deciphering the fingerprint of the chronic inflammation orchestrated by CD8 T cells may allow the development of novel approaches to COPD management. Here, the expression of IL-27 and IFN-γ CD8 Tc1 cells were evaluated in patients with COPD and in cigarette smoke exposed mice. Read More

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September 2021

Immunohistochemical comparison of three programmed death-ligand 1 (PD-L1) assays in triple-negative breast cancer.

PLoS One 2021 24;16(9):e0257860. Epub 2021 Sep 24.

Department of Surgery, Kansai Medical University, Osaka, Japan.

Background: Triple-negative breast cancer (TNBC) is the most aggressive type of breast cancer. A recent study demonstrated the efficacy of anti-PD-L1 (anti-programmed death ligand-1) immunotherapy in patients with TNBC. However, the identification of TNBC patients who may benefit from immunotherapy is a critical issue. Read More

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September 2021

Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients.

PLoS One 2021 24;16(9):e0257558. Epub 2021 Sep 24.

Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Background: Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear.

Methods: From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Read More

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September 2021

eARDS: A multi-center validation of an interpretable machine learning algorithm of early onset Acute Respiratory Distress Syndrome (ARDS) among critically ill adults with COVID-19.

PLoS One 2021 24;16(9):e0257056. Epub 2021 Sep 24.

Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, United States of America.

We present an interpretable machine learning algorithm called 'eARDS' for predicting ARDS in an ICU population comprising COVID-19 patients, up to 12-hours before satisfying the Berlin clinical criteria. The analysis was conducted on data collected from the Intensive care units (ICU) at Emory Healthcare, Atlanta, GA and University of Tennessee Health Science Center, Memphis, TN and the Cerner® Health Facts Deidentified Database, a multi-site COVID-19 EMR database. The participants in the analysis consisted of adults over 18 years of age. Read More

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September 2021

Study of Dignity in Borderline Contexts: Perspectives and Critical Issues.

Psychiatr Danub 2021 Sep;33(Suppl 9):86-87

NIDi (Network Italiano per la Dignità nella Cura), Neamente Neuroscience Association, Via Lorenzo Ferrante n. 100, 83100 Avellino, Italy,

In 2020 Dignity Therapy Protocol was administered to the patients taken in charge by Avellino Ser. D (Addiction services of Avellino healthcare unit) for addiction problems and assigned to U.E. Read More

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September 2021

At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery?

Spine (Phila Pa 1976) 2021 Oct;46(20):E1113-E1118

Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA.

Study Design: Retrospective cohort study.

Objective: The aim of this study was to investigate the impact of cervical to thoracolumbar ratios on poor outcomes in cervical deformity (CD) corrective surgery.

Summary Of Background Data: Consideration of distal regional and global alignment is a critical determinant of outcomes in CD surgery. Read More

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October 2021

Effects of Curcuma longa L., Eucommia ulmoides Oliv. and Gynostemma pentaphyllum (Thunb.) Makino on Cytokine Production in Stimulated Peripheral Blood Mononuclear Cells in Patients with Tuberculosis.

Altern Ther Health Med 2021 Sep 24. Epub 2021 Sep 24.

Background: Tuberculosis (TB) infection triggers the innate and adaptive immune responses. Eucommia ulmoides Oliv., Gynostemma pentaphyllum (Thunb. Read More

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September 2021

The PUPPY Study: Protocol for a Longitudinal Mixed Methods Study Exploring Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year.

JMIR Res Protoc 2021 Sep 9. Epub 2021 Sep 9.

Queen's University, Kingston, CA.

Background: The COVID-19 pandemic significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible, pharmacies remaining open with restrictions on patient interactions, rapid uptake of virtual care, and reduced referrals for lab tests, diagnostics, and specialist care. The PUPPY Study (Problems Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of COVID-19 across the quadruple aim of primary care, with particular focus on the impacts on patients without attachment to a regular provider and those with chronic health conditions.

Objective: The PUPPY Study objective is to understand the impact of COVID-19 across the quadruple aim of primary care. Read More

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September 2021

Analyses of Original and Computationally-Derived Electronic Health Record Data: The National COVID Cohort Collaborative.

J Med Internet Res 2021 Sep 12. Epub 2021 Sep 12.

Department of Biomedical and Medical Education, School of Medicine, University of Washington, Seattle, US.

Background: Computationally-derived ("synthetic") data can enable the creation and analysis of clinical, laboratory, and diagnostic data as if they were the original electronic health record (EHR) data. Synthetic data can support data sharing to answer critical research questions to address the COVID-19 pandemic.

Objective: We aimed to (1) compare the results from analyses of synthetic data to those from original data, and (2) assess the strengths and limitations of leveraging computationally-derived data for research purposes. Read More

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September 2021