The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Gunther Schadow - One of the best experts on this subject based on the ideXlab platform.
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structured product labeling improves detection of drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Objectives: This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design: The Regenstrief Institute CPOE drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-Intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements: The number of drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct Intolerances. The difference between drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results: Although <70% of terms were mapped to SPL, the new approach detected four times as many drug-Intolerance issues on twice as many patients. Conclusion: The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-Intolerance decision support and suggests how terminology and methods of recording drug Intolerances could be improved.
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structured product labeling improves detection of drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-Intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct Intolerances. The difference between drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-Intolerance decision support and suggests how terminology and methods of recording drug Intolerances could be improved.
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structured product labeling improves detection of drug Intolerance issues
Journal of the American Medical Informatics Association, 2009Co-Authors: Gunther SchadowAbstract:Abstract Objectives This study sought to assess the value of the Health Level 7/U.S. Food and Drug Administration Structured Product Labeling (SPL) drug knowledge representation standard and its associated terminology sources for drug-Intolerance (allergy) decision support in computerized provider order entry (CPOE) systems. Design The Regenstrief Institute CPOE drug-Intolerance issue detection system and its knowledge base was compared with a method based on existing SPL label content enriched with knowledge sources used with SPL (NDF-RT/MeSH). Both methods were applied to a large set of drug-Intolerance (allergy) records, drug orders, and medication dispensing records covering >50,000 patients over 30 years. Measurements The number of drug-Intolerance issues detected by both methods was counted, as well as the number of patients with issues, number of distinct drugs, and number of distinct Intolerances. The difference between drug-Intolerance issues detected or missed by either method was qualitatively analyzed. Results Although Conclusion The SPL-based approach is more sensitive and suggests that mapping local dictionaries to SPL, and enhancing the depth and breadth of coverage of SPL content are worth accelerating. The study also highlights specificity problems known to trouble drug-Intolerance decision support and suggests how terminology and methods of recording drug Intolerances could be improved.
Michael Fried - One of the best experts on this subject based on the ideXlab platform.
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lactose Intolerance in irritable bowel syndrome patients with diarrhoea the roles of anxiety activation of the innate mucosal immune system and visceral sensitivity
Alimentary Pharmacology & Therapeutics, 2014Co-Authors: Jianfeng Yang, Yanqun Cong, Xia Zheng, Yanqin Long, Michael FriedAbstract:Summary Background Irritable bowel syndrome patients with diarrhoea (IBS-D) often report Intolerance to milk; however, the mechanism underlying these symptoms is unknown. Aim To assess the role of psychological factors, immune activation and visceral sensitivity on the development of lactose Intolerance (LI) in IBS-D patients. Methods Fifty-five IBS-D patients and 18 healthy controls (HCs) with lactase deficiency underwent a 20-g lactose hydrogen breath test (LHBT). Patients were categorised as lactose malabsorption (LM; malabsorption only) or LI [malabsorption plus increase in total symptom score (TSS). Measurements included (i) psychological status; (ii) enteric biopsies with quantification of mast cells (MCs), T-lymphocytes and enterochromaffin cells; (iii) serum cytokines; (iv) rectal sensitivity before and after lactose ingestion. Results LI was more prevalent in IBS-D patients than HCs [25/55 (46%) vs. 3/18 (17%), P = 0.029]. IBS-D patients with LI had (i) higher levels of anxiety than those with LM (P = 0.017) or HCs (P = 0.006); (ii) increased mucosal MCs compared with LM (P = 0.006) and HCs (P < 0.001); (iii) raised serum TNF-α compared with LM (P = 0.034) and HCs (P < 0.001) and (iv) increased rectal sensitivity after lactose ingestion compared with LM (P < 0.001) or HCs (P < 0.001). Severity of abdominal symptoms after lactose ingestion was associated with the increase in visceral sensitivity after lactose intake (r = 0.629, P < 0.001), MCs (r = 0.650, P < 0.001) and anxiety (r = 0.519, P < 0.001). Conclusions IBS-D patients with lactose intolerence are characterised by anxiety, mucosal immune activation and increased visceral sensitivity after lactose ingestion. The presence of these biomarkers may indicate an IBS phenotype that responds to dietary therapy and/or mast cell stabilisers (ClinicalTrials.gov Identifier: NCT01286597).
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lactose malabsorption and Intolerance pathogenesis diagnosis and treatment
United European gastroenterology journal, 2013Co-Authors: Benjamin Misselwitz, Michael Fried, Daniel Pohl, Heiko Fruhauf, Stephan R VavrickaAbstract:Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose Intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose Intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose Intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose Intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose Intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and Intolerance.
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lactose Intolerance in patients with chronic functional diarrhoea the role of small intestinal bacterial overgrowth
Alimentary Pharmacology & Therapeutics, 2010Co-Authors: Jianmin Zhao, Yanqun Cong, Y. Shang, Michael FriedAbstract:SUMMARY Background Many studies report a high prevalence of lactose Intolerance in patients with functional, gastrointestinal disease. Aim To evaluate the role of small intestinal bacterial overgrowth (SIBO) in condition of lactose Intolerance and the mechanism by which SIBO may impact lactose tolerance in affected patients. Methods Consecutive out-patients with chronic functional diarrhoea (CFD) and healthy controls underwent a validated 20 g lactose hydrogen breath test (HBT). Patients completed also a 10 g lactulose HBT with concurrent assessment of small bowel transit by scintigraphy. Results Lactose malabsorption was present in 27 ⁄ 31 (87%) patients with CFD and 29 ⁄ 32 (91%) healthy controls (P = 0.708). From the patient group 14 ⁄ 27 (52%) had lactose Intolerance and 13 ⁄ 27 (48%) experienced no symptoms (lactose malabsorption controls). Only 5 (17%) healthy controls reported symptoms (P < 0.01). The oro-caecal transit time was similar between patient groups with or without symptoms (P = 0.969). SIBO was present in 11 (41%) subjects and was more prevalent in lactose Intolerance than in lactose malabsorption [9 ⁄ 14 (64%) vs. 2 ⁄ 13 (15%), P = 0.018]. Symptom severity was similar in lactose Intolerance patients with and without SIBO (P = 0.344). Conclusions Small intestinal bacterial overgrowth increases the likelihood of lactose Intolerance in patients with CFD as a direct result of lactose fermentation in the small intestine, independent of oro-caecal transit time and visceral sensitivity.
Diane L Seger - One of the best experts on this subject based on the ideXlab platform.
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prevalence of food allergies and Intolerances documented in electronic health records
The Journal of Allergy and Clinical Immunology, 2017Co-Authors: Kimberly G Blumenthal, Warren W Acker, Joseph M Plasek, Kenneth H Lai, Maxim Topaz, Diane L SegerAbstract:Background Food allergy prevalence is reported to be increasing, but epidemiological data using patients' electronic health records (EHRs) remain sparse. Objective We sought to determine the prevalence of food allergy and Intolerance documented in the EHR allergy module. Methods Using allergy data from a large health care organization's EHR between 2000 and 2013, we determined the prevalence of food allergy and Intolerance by sex, racial/ethnic group, and allergen group. We examined the prevalence of reactions that were potentially IgE-mediated and anaphylactic. Data were validated using radioallergosorbent test and ImmunoCAP results, when available, for patients with reported peanut allergy. Results Among 2.7 million patients, we identified 97,482 patients (3.6%) with 1 or more food allergies or Intolerances (mean, 1.4 ± 0.1). The prevalence of food allergy and Intolerance was higher in females (4.2% vs 2.9%; P P Conclusions Our findings are consistent with previously validated methods for studying food allergy, suggesting that the EHR's allergy module has the potential to be used for clinical and epidemiological research. The spectrum of severity observed with food allergy highlights the critical need for more allergy evaluations.
Marat V Ezhov - One of the best experts on this subject based on the ideXlab platform.
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statin Intolerance an attempt at a unified definition position paper from an international lipid expert panel
Archives of Medical Science, 2015Co-Authors: Maciej Banach, Manfredi Rizzo, Peter P Toth, Michel Farnier, Michael H Davidson, Khalid Alrasadi, Wilbert S Aronow, Vasilis G Athyros, D Djuric, Marat V EzhovAbstract:Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin Intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin Intolerance, which might be observed in 10-15% of patients. In clinical practice, statin Intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin Intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin Intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
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statin Intolerance an attempt at a unified definition position paper from an international lipid expert panel
Archives of Medical Science, 2015Co-Authors: Maciej Banach, Manfredi Rizzo, Peter P Toth, Michel Farnier, Michael H Davidson, Khalid Alrasadi, Wilbert S Aronow, Vasilis G Athyros, Dragan M Djuric, Marat V EzhovAbstract:Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term ‘statin Intolerance’. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin Intolerance, which might be observed in 10–15% of patients. In clinical practice, statin Intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin Intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin Intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
Benjamin Misselwitz - One of the best experts on this subject based on the ideXlab platform.
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lactose Intolerance in adults biological mechanism and dietary management
Nutrients, 2015Co-Authors: Yanyong Deng, Benjamin MisselwitzAbstract:Lactose Intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose Intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose Intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose Intolerance can be part of a wider Intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose Intolerance.
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lactose malabsorption and Intolerance pathogenesis diagnosis and treatment
United European gastroenterology journal, 2013Co-Authors: Benjamin Misselwitz, Michael Fried, Daniel Pohl, Heiko Fruhauf, Stephan R VavrickaAbstract:Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose Intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose Intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose Intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose Intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose Intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and Intolerance.
