Translating clinical notes into quantitative measures-a real-world observation on the response to cholinesterase inhibitors or selective serotonin reuptake inhibitors prescribed to outpatients with dementia using electronic medical records.
Translating clinical notes into quantitative measures-a real-world observation on the response to cholinesterase inhibitors or selective serotonin reuptake inhibitors prescribed to outpatients with dementia using electronic medical records.
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DOI：
10.3389/fphar.2023.1177026
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发表时间：
2023
影响因子：
5.6
通讯作者：
Oishi, Kenichi
中科院分区：
文献类型：
--
作者：
Chotiyanonta, Jill S. S.;Onda, Kengo;Nowrangi, Milap A. A.;Li, Xin;Xu, Xin;Adams, Roy;Lyketsos, Constantine G. G.;Zandi, Peter;Oishi, Kenichi
关键词：
目的：胆碱酯酶抑制剂（CEIs）用于治疗痴呆症以维持或改善记忆。选择性血清素再摄取抑制剂（SSRI）也用于控制痴呆症中出现的精神症状。目前尚不清楚有多少门诊患者真正对这些药物有反应。我们的目标是使用电子病历 (EMR) 调查门诊环境中这些药物的反应率。 方法：我们使用约翰·霍普金斯大学 EMR 系统来识别 2010 年至 2021 年间首次服用 CEI 或 SSRI 的痴呆患者。通过常规记录的临床记录和自由文本条目（医疗保健提供者在其中记录临床发现和患者印象）来评估治疗效果。除了临床医生基于访谈的变化印象加上护理人员输入 (CIBIC-plus)（临床试验中使用的七点李克特量表）之外，还使用名为基于 NOte 的治疗效果评估方法 (NOTE) 的三点李克特量表对反应进行评分。为了验证NOTE，我们检查了NOTE与CIBIC-plus之间以及NOTE与用药前后MMSE（简易精神状态检查）变化之间的关系。使用 Krippendorff 的 alpha 评估评估者间的可靠性。计算了响应者率。 结果：NOTE 显示出出色的评估者间可靠性，并与 CIBIC-plus 和 MMSE 变化良好相关。在 115 例 CEI 病例中，27.0% 的患者表示认知症状有所改善，34.8% 的患者表示认知症状稳定；在 225 例 SSRI 病例中，69.3% 的患者报告神经精神症状有所改善。 结论：NOTE 在基于非结构化临床条目衡量药物治疗效果方面显示出高度有效性。尽管我们的现实世界观察包括各种类型的痴呆症，但结果与阿尔茨海默病及其相关神经精神症状的对照临床试验中报告的结果非常相似。
Objective: Cholinesterase inhibitors (CEIs) are prescribed for dementia to maintain or improve memory. Selective serotonin reuptake inhibitors (SSRIs) are also prescribed to manage psychiatric symptoms seen in dementia. What proportion of outpatients actually responds to these drugs is still unclear. Our objective was to investigate the responder rates of these medications in an outpatient setting using the electronic medical record (EMR). Methods: We used the Johns Hopkins EMR system to identify patients with dementia who were prescribed a CEI or SSRI for the first time between 2010 and 2021. Treatment effects were assessed through routinely documented clinical notes and free-text entries in which healthcare providers record clinical findings and impressions of patients. Responses were scored using a three-point Likert scale named the NOte-based evaluation method for Treatment Efficacy (NOTE) in addition to the Clinician’s Interview-Based Impression of Change Plus caregiver input (CIBIC-plus), a seven-point Likert scale used in clinical trials. To validate NOTE, the relationships between NOTE and CIBIC-plus and between NOTE and change in MMSE (Mini-Mental State Examination) before and after medication were examined. Inter-rater reliability was evaluated using Krippendorff’s alpha. The responder rates were calculated. Results: NOTE showed excellent inter-rater reliability and correlated well with CIBIC-plus and changes in MMSEs. Out of 115 CEI cases, 27.0% reported improvement and 34.8% reported stable symptoms in cognition; out of 225 SSRI cases, 69.3% reported an improvement in neuropsychiatric symptoms. Conclusion: NOTE showed high validity in measuring the pharmacotherapy effects based on unstructured clinical entries. Although our real-world observation included various types of dementia, the results were remarkably similar to what was reported in controlled clinical trials of Alzheimer’s disease and its related neuropsychiatric symptoms.
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影响因子：
2.4
作者：
Lyketsos, CG;Lee, HCB
通讯作者：
Lee, HCB
影响因子：
4
作者：
Finkel, SI;Mintzer, JE;McRae, T
通讯作者：
McRae, T
DOI：
10.1186/alzrt155
发表时间：
2013
期刊：
Alzheimer's research & therapy
影响因子：
--
作者：
Lam B;Masellis M;Freedman M;Stuss DT;Black SE
通讯作者：
Black SE
影响因子：
17.7
作者：
Trivedi, MH;Rush, AJ;Fava, M
通讯作者：
Fava, M
影响因子：
168.9
作者：
Banerjee, Sube;Hellier, Jennifer;Burns, Alistair
通讯作者：
Burns, Alistair